Robotic-assisted laparoscopic versus abdominal and laparoscopic myomectomy: A systematic review and meta-analysis.

BACKGROUND: Myomectomy is the preferred treatment for women with uterine fibroids and fertility requirements. There are three modalities are used in clinical practice for myomectomy: abdominal myomectomy (AM), laparoscopic myomectomy (LM), and robot-assisted laparoscopic myomectomy (RLM). OBJECTIVES: To compare the perioperative and postoperative outcomes of RLM, AM, and LM. SEARCH STRATEGY: We searched PubMed, Web of Science, Embase, and Clinical Trials for relevant literature published between January 2000 and January 2023. SELECTION CRITERIA: We included all studies reporting peri- and postoperative outcomes of myomectomy in patients with uterine myomas. Surgical treatments were classified as RLM, LM, or AM. DATA COLLECTION AND ANALYSIS: Two or more authors selected studies independently, assessed risk of bias, and extracted data. We derived mean difference (MD) or odds ratio (OR) with 95% confidence intervals (CIs) for each outcome, subgrouping trials by the patient characteristics and myoma characteristics. We used the I2 statistic to quantify heterogeneity and the random-effects model for meta-analysis when appropriate. We used the funnel plot to assess the publication bias. MAIN RESULTS: A total of 32 studies with 6357 patients were included, of which 1982 women had undergone RLM. The operating time was significantly longer (MD = 43.58, 95% confidence interval [CI]: 25.22-61.93, P < 0.001), and the incidence of cesarean section after myomectomy was significantly lower (OR = 0.27, 95% CI: 0.10-0.78, P = 0.02) in RLM than in LM. Compared with AM, the operation time, blood loss, blood transfusion rate, complication rate, total cost, length of hospital stay, and pregnancy rate of patients with RLM were significantly different. CONCLUSIONS: The safety and effectiveness of RLM are superior to those of AM but inferior to those of LM.

Polysomnography and Neuropsychological Analysis of Patients With Post-Traumatic Stress Disorder Two Years After the COVID-19 Pandemic in Wuhan.

OBJECTIVE: We used polysomnography (PSG) monitoring and neuropsychological scales to explore the characteristics of coronavirus disease-2019 (COVID-19) patients diagnosed with post-traumatic stress disorder (PTSD) in Wuhan, two years after the onset of the COVID-19 pandemic. METHODS: A total of 42 patients in the Sleep Medicine Center were diagnosed with insomnia between December 2021 and May 2022; they were divided into the PTSD group (patients with PTSD diagnosed with insomnia after COVID-19 infection) and the non-PTSD group (patients with insomnia without PTSD). A healthy control group was simultaneously included. RESULTS: The PTSD group was more significant than the non-PTSD group in partial manifestations of sleep disorders, neuropsychological clinical symptoms, and partial PSG data. Patients with different COVID-19 subtypes showed significant differences in the course of disease, sleep disorders, neuropsychological clinical symptoms, relevant scale scores, and PSG data analysis. CONCLUSION: The emotional anxiety and depression of COVID-19 patients diagnosed with PTSD two years after the COVID-19 pandemic in Wuhan are more significant, and will not be self-alleviated with the passage of time. It is necessary to continue to pay attention to the PTSD symptoms and sleep psychology of COVID-19 infected patients, and take appropriate measures. Patients with severe and critical COVID-19 have more severe sleep and mental disorders, and there is a significant correlation between the duration of the disease and the severity of mental and mental disorders and sleep disorders after recovery.

Ultralow-Friction at Cryogenic Temperature Induced by Hydrogen Correlated Quantum Effect.

Temperature is one of the governing factors affecting friction of solids. Undesired high friction state has been generally reported at cryogenic temperatures due to the prohibition of thermally activated processes, following conventional Arrhenius equation. This has brought huge difficulties to lubrication at extremely low temperatures in industry. Here, the study uncovers a hydrogen-correlated sub-Arrhenius friction behavior in hydrogenated amorphous carbon (a-C:H) film at cryogenic temperatures, and a stable ultralow-friction over a wide temperature range (103-348 K) is achieved. This is attributed to hydrogen-transfer-induced mild structural ordering transformation, confirmed by machine-learning-based molecular dynamics simulations. The anomalous sub-Arrhenius temperature dependence of structural ordering transformation rate is well-described by a quantum mechanical tunneling (QMT) modified Arrhenius model, which is correlated with quantum delocalization of hydrogen in tribochemical reactions. This work reveals a hydrogen-correlated friction mechanism overcoming the Arrhenius temperature dependence and provides a new pathway for achieving ultralow friction under cryogenic conditions.

Alcohol Expectancies for Sexual Enhancement, Event-Level Alcohol Use, and Likelihood of Sexual Aggression Perpetration: A Timeline Followback Approach.

Sexual aggression (SA) is a significant public health problem, with the majority of SA involving alcohol. The present study examined associations between alcohol expectancies for sexual enhancement, event-level alcohol use, and the likelihood of SA perpetration. Young, adult non-problem drinking men participated in a laboratory session and completed a background survey that included measures of alcohol expectancies. Subsequently, men completed 6-week and 3-month follow-up surveys in which they reported their sexual experiences each day during the intervening 6-week period using Timeline Followback procedures. The analytic sample consisted of the 421 men (Mage = 24.66, SD = 2.69) who reported having sex at least once during the follow-up period. Multilevel models showed a significant alcohol expectancies X alcohol use interaction at the between-person level: Controlling for time and alcohol expectancies for aggression, stronger alcohol expectancies for sexual enhancement were associated with greater SA perpetration likelihood among men who consumed high amounts of alcohol before sexual encounters but not among men who consumed low amounts. Alcohol prevention programs should consider addressing men's alcohol expectancies for sexual enhancement to reduce risk for SA perpetration.

Subthreshold micropulse laser therapy for early postoperative macular thickening following surgical removal of epiretinal membrane.

BACKGROUND: This study aimed to investigate the functional and anatomical outcomes of subthreshold micropulse laser (SMPL) therapy in eyes with early postoperative macular thickening after idiopathic epiretinal membrane (iERM) removal. METHODS: This was a prospective and interventional study. Forty-eight eyes from 48 patients with macular edema at 1 month after iERM removal were randomly divided into two groups. Patients in the SMPL group (n = 24) received SMPL therapy while no special intervention was used for the observation group (n = 24). Baseline demographic data and clinical findings before and at 1 and 3 months after SMPL treatment or observation, including best-corrected visual acuity (BCVA) and the changes in central subfield thickness (CST) and average macular thickness (AMT), were analyzed. RESULTS: An improvement in BCVA with a decrease in CST and AMT from baseline to the 3-month follow-ups were observed in both SMPL and observation groups. No significant difference in BCVA was observed between the SMPL group and observation group either in the 1-month (0.26 [0.15, 0.52] vs. 0.26 [0.15, 0.39], P = 0.852) or the 3-month (0.15 [0.10, 0.30] vs. 0.23 [0.15, 0.30], P = 0.329) follow-up. There was a greater reduction in CST in the SMPL group versus observation group between baseline and the 3-month follow-up (-77.8 ± 72.3 µm vs. -45.0 ± 46.9 µm, P = 0.049). The alteration in AMT did not differ between the two groups in either 1-month (-16.5 ± 20.1 µm vs. -19.7 ± 16.3 µm, P = 0.547) or 3-month (-36.9 ± 26.9 µm vs. -34.0 ± 20.1 µm, P = 0.678) follow-up. CONCLUSIONS: SMPL therapy led to a significant decrease in CST at the 3-month follow-up while did not significantly improve the visual acuity in patients with postoperative macular thickening following iERM surgery. TRIAL REGISTRATION: The study was registered on Aug 27, 2020 (Trial Registration Number: ChiCTR 2000037227).

Preliminary Efficacy of Mindfulness and Cognitive Restructuring Interventions to Reduce Nonconsensual Sex Intentions.

OBJECTIVE: Victims of sexual violence experience detrimental physical and mental health consequences. Therefore, developing programs to prevent sexual violence is of utmost importance. Our previous work provided preliminary support for the efficacy of brief mindfulness and cognitive restructuring (CR) interventions in reducing sexual violence intentions. Because alcohol use and alcohol expectancies (AE) have been identified as risk factors for sexual violence, this secondary data analysis aimed to examine whether alcohol use and men's expectations that alcohol may affect women's vulnerability of being sexually coerced moderate the usefulness of these two interventions on nonconsensual sex intentions. METHOD: Single, young, heterosexual, heavy episodic drinking men with sexual violence histories were randomly assigned to receive mindfulness or CR skills training, or attention control. Half of the participants in each intervention condition were then randomized to alcohol or sober conditions. All participants read a hypothetical sexual scenario and rated their intention to engage in nonconsensual sex with their hypothetical sexual partner. RESULTS: Mindfulness was effective in lowering nonconsensual sex intentions among sober men with high AE for women's vulnerability and intoxicated men with low AE for women's vulnerability to sexual coercion. CR was effective in lowering nonconsensual sex intentions among intoxicated men with low and moderate AE for women's vulnerability to sexual coercion. CONCLUSIONS: Our results provide preliminary evidence for the efficacy of mindfulness and CR in lowering nonconsensual sex intentions under certain circumstances and highlight men's AE about women's vulnerability to sexual coercion as a critical factor that interacts with alcohol use to influence the efficacy of mindfulness and CR.

Identifying High-Cost, High-Need Patients in a Network of Community Hospitals.

We examined healthcare costs at HonorHealth, a community-based academic health center comprised of 5 hospitals and numerous ambulatory care facilities. Patient encounters that resulted in admission in 2019 were included in the study. Mean costs in 2019 for high costs and high needs (HCHN) patients were compared with all remaining patients using a framework developed by the National Academy of Medicine. HCHN patients were older (71 vs 52 years), with a lower percentage of females (41.7% vs 59.8%), more frequently White (90.1% vs 87.5%), less frequently married (52.4% vs 54.5%), with a longer length of stay (6.5 vs 3.0 days) and higher mean charges ($134 743 vs $16 414). The mean cost per patient in the HCHN group decreased by age group ($192, 963, $165 200, $144 584, $134 795, and $108 356) for 0 to 18, 19 to 44, 45 to 64, 65 to 84, and 85+ years, respectively. HCHN patients were more publicly insured (49% vs 38%). Targeted interventions to treat HCHN may lead to lower healthcare costs and improved health outcomes within this system.

Uncovering the mechanism of Tenofovir amibufenamide fumarate punch sticking by combining direct compression experiment and computational simulation.

Punch sticking during tablet manufacturing is a prevalent issue for many active pharmaceutical ingredients (APIs) encountered by the pharmaceutical industry. Tenofovir amibufenamide fumarate (TMF), a heavyweight drug for the treatment of hepatitis B, was selected as a model drug due to its tendency to punch sticking during tablet compression. In this study, the cause of sticking was explored by investigating crystal habits, excipients and structure characteristics. The difference in sticking of three crystal habits can be visually represented through direct compression experiments on powdered samples and analysis of crystal surfaces. The excipients play a direct role in decreasing the probability of sticking, and the extent of sticking can be assessed by measuring the tensile strength of the tablet. Additionally, the plasticity index was utilized to theoretically analyze the potential enhancements of four excipients. These experimental results indicate that the block-shaped crystals have superior ability of anti-sticking and that suitable excipients can significantly improve the sticking situation of TMF. Ultimately, the phenomenon of punch sticking was additionally examined through computational calculations, focusing on the mechanical characteristics of TMF molecules and intermolecular interactions. The strategy of combining experiments and simulation calculations has broader significance for the study of drug production.

The effects of different doses of lanthanum-modified bentonite in combination with a submerged macrophyte (Vallisneria denseserrulata) on phosphorus inactivation and macrophyte growth: A mesocosm study.

The combination of chemical phosphorus (P) inactivation and submerged macrophyte transplantation has been widely used in lake restoration as it yields stronger effects than when applying either method alone. However, the dose effect of chemical materials on P inactivation when used in combination with submerged macrophytes and the influences of the chemicals used on the submerged macrophytes growth remain largely unknown. In this study, we investigated P inactivation in both the water column and the sediment, and the responses of submerged macrophytes to Lanthanum modified bentonite (LMB) in an outdoor mesocosm experiment where Vallisneria denseserrulata were transplanted into all mesocosms and LMB was added at four dosage levels, respectively: control (LMB-free), low dosage (570 g m-2), middle dosage (1140 g m-2), and high dosage (2280 g m-2). The results showed that the combination of LMB dosage and V. denseserrulata reduced TP in the water column by 32%-38% compared to V. denseserrulata alone, while no significant difference was observed among the three LMB treatments. Porewater soluble reactive P, two-dimensional diffusive gradient in thin films (DGT)-labile P concentrations, and P transformation in the 0-1 cm sediment layer exhibited similar trends along the LMB dosage gradient. Besides, LMB inhibited plant growth and reduced the uptake of mineral elements (i.e., calcium, manganese, iron, and magnesium) in a dosage-dependent manner with LMB. LMB may reduce plant growth by creating a P deficiency risk for new ramets and by interfering with the uptake of mineral elements. Considering both the dose effect of LMB on P inactivation and negative effect on macrophyte growth, we suggest a "small dosage, frequent application" method for LMB application to be used in lake restoration aiming to recover submerged macrophytes and clear water conditions.

A Pilot Study to Assess the Suitability of Riboflavin as A Surrogate Marker of Breast Cancer Resistance Protein (BCRP) in Healthy Participants.

We recently showed that riboflavin is a selected substrate of BCRP over P-gp and demonstrated its prediction performance in preclinical DDI studies. The aim of this study was to investigate the suitability of riboflavin to assess BCRP inhibition in humans. First, we assessed the substrate potential of riboflavin towards other major drug transporters using established transfected cell systems. Riboflavin is a substrate for OAT1, OAT3, and MATE2-K with uptake ratios ranging from 2.69 to 11.6 but riboflavin is not a substrate of OATP1B1, OATP1B3, OCT2, and MATE1. The effects of BMS-986371, a potent in vitro inhibitor of BCRP (IC 50 0.40 µM), on the pharmacokinetics of riboflavin, isobutyryl carnitine, and arginine were then examined in healthy male adults (N = 14 or 16) following oral administration of methotrexate (MTX) (7.5 mg) and enteric coated (EC) sulfasalazine (SSZ) (1,000 mg) alone or in combination with BMS-986371 (150 mg). Oral administration of BMS-986371 increased the AUCs of rosuvastatin and immediate-release (IR) SSZ to 1.38- and 1.51-fold , respectively, and significantly increased AUC(0-4h), AUC(0-24h), and C max of riboflavin by 1.25-, 1.14-, and 1.11-fold (P-values of 0.003, 0.009, and 0.025, respectively) compared to the MTX/SSZ EC alone group. In contrast, BMS-986371 did not significantly influence the AUC(0-24h) and C max values of isobutyryl carnitine and arginine (0.96- to 1.07-fold, respectively; P > 0.05). Overall, these data indicate that plasma riboflavin is a promising biomarker of BCRP that may offer a possibility to assess drug candidate as a BCRP modulator in early drug development. Significance Statement Endogenous compounds that serve as biomarkers for clinical inhibition of BCRP are not currently available. This study provides the initial evidence that riboflavin is a promising BCRP biomarker in humans. For the first time, the value of leveraging the substrate of BCRP with acceptable prediction performance in clinical studies is shown. Additional clinical investigations with known BCRP inhibitors are needed to fully validate and showcase the utility of this biomarker.

Receipt of Coercive Condom Use Resistance: A Scoping Review.

Condom use resistance (CUR) refers to practices used to obtain unprotected sex with a partner who wishes to use a condom. Coercive CUR is a manipulative and aggressive form of CUR, which is associated with detrimental mental, physical, and sexual health consequences. This review synthesizes quantitative evidence on the prevalence and correlates of experiencing coercive CUR. A systematic approach, including title, abstract, and full-text review, was used to identify relevant empirical studies. Thirty-seven articles met the inclusion criteria. Prevalence of experiencing coercive CUR ranged from 0.1% to 59.5%. Significant correlates of receiving coercive CUR included interpersonal violence, sexually transmitted infection (STI) diagnosis, emotional stress, and drug use. Importantly, vulnerable populations (e.g., racial/ethnic minorities, men who have sex with men, sex workers) and people with low perceived control and resistive efficacy (i.e., the ability to say "no") had an increased likelihood of experiencing coercive CUR. Methodological weaknesses in the current literature include a lack of longitudinal studies and studies that examine the effectiveness of interventions, as well as failure to use consistent measures and include samples of men and sexual minorities. Future research should address these limitations. Intervention and prevention strategies should prioritize populations that are at greater risk for experiencing coercive CUR to achieve better health equity outcomes.

Silicon dioxide nanoparticles enhance plant growth, photosynthetic performance, and antioxidants defence machinery through suppressing chromium uptake in Brassica napus L.

Chromium (Cr) is a highly toxic heavy metal that is extensively released into the soil and drastically reduces plant yield. Silicon nanoparticles (Si NPs) were chosen to mitigate Cr toxicity due to their ability to interact with heavy metals and reduce their uptake. This manuscript explores the mechanisms of Cr-induced toxicity and the potential of Si NPs to mitigate Cr toxicity by regulating photosynthesis, oxidative stress, and antioxidant defence, along with the role of transcription factors and heavy metal transporter genes in rapeseed (Brassica napus L.). Rapeseed plants were grown hydroponically and subjected to hexavalent Cr stress (50 and 100 µM) in the form of K2Cr2O7 solution. Si NPs were foliar sprayed at concentrations of 50, 100 and 150 µM. The findings showed that 100 µM Si NPs under 100 µM Cr stress significantly increased the leaf Si content by 169% while reducing Cr uptake by 92% and 76% in roots and leaves, respectively. The presence of Si NPs inside the plant leaf cells was confirmed by using energy-dispersive spectroscopy, inductively coupled plasma‒mass spectrometry, and confocal laser scanning microscopy. The study's findings showed that Cr had adverse effects on plant growth, photosynthetic gas exchange attributes, leaf mesophyll ultrastructure, PSII performance and the activity of enzymatic and nonenzymatic antioxidants. However, Si NPs minimized Cr-induced toxicity by reducing total Cr accumulation and decreasing oxidative damage, as evidenced by reduced ROS production (such as H2O2 and MDA) and increased enzymatic and nonenzymatic antioxidant activities in plants. Interestingly, Si NPs under Cr stress effectively increased the NPQ, ETR and QY of PSII, indicating a robust protective response of PSII against stress. Furthermore, the enhancement of Cr tolerance facilitated by Si NPs was linked to the upregulation of genes associated with antioxidant enzymes and transcription factors, alongside the concurrent reduction in metal transporter activity.

Preliminary Efficacy of a Brief Cognitive Restructuring Intervention to Reduce Sexual Coercion Intentions: Roles of Alcohol and Emotion Regulation.

Sexual coercion (SC), the use of nonphysical tactics to obtain sexual contact with a nonconsenting partner, is a prevalent form of sexual misconduct that is associated with several physical and psychological health concerns. Therefore, effective preventative interventions to reduce SC prevalence are needed. Alcohol consumption and difficulties in emotion regulation (ER) are two risk factors that contribute to SC. Cognitive restructuring (CR) has the potential to reduce SC intentions by improving ER through actively challenging one's thoughts to modify emotions. This study represents a secondary data analysis to examine the effectiveness of a brief, web-based CR intervention in reducing SC intentions. To test whether the intervention would remain beneficial in the presence of alcohol, we tested effects among intoxicated versus sober participants. Young, male, heavy episodic drinkers with a history of sexual aggression (N = 137) were randomized into a CR intervention versus control condition as well as alcohol consumption versus no alcohol condition. Then, participants completed a sexual aggression analog scenario. General linear regression analyses showed that intoxicated men reported stronger SC intentions than sober men. Additionally, relative to controls, men in the CR condition who had better preexisting ER cognitive reappraisal skills had significantly lower SC intentions. Our findings provide preliminary support for CR as an effective strategy to reduce SC intentions among sexually aggressive, heavy episodic drinking men with better cognitive reappraisal skills. If findings are replicated, this brief, web-based CR intervention could overcome potential challenges in dissemination and be easily applied in clinical settings.

Tirofiban combined with Aspirin in the Treatment of Acute Penetrating Artery Territory Infarction (STRATEGY): protocol for a multicentre, randomised controlled trial.

BACKGROUND: Perforating artery territorial infarction (PAI) caused by branch atheromatous disease (BAD) is prone to recurrence and early progression without an effective and well-documented antiplatelet treatment regimen. Tirofiban, an adjunctive antiplatelet agent, has shown great potential to treat acute ischaemic stroke. However, whether the combination of tirofiban and aspirin can improve the prognosis of PAI remains unclear. AIM: To explore an effective and safe antiplatelet regimen for reducing the risk of recurrence and early neurological deterioration (END) in PAI caused by BAD by comparing the tirofiban and aspirin combination with placebo and aspirin combination. METHODS: Tirofiban combined with Aspirin in the Treatment of Acute Penetrating Artery Territory Infarction (STRATEGY) trial is an ongoing multicentre, randomised, placebo-controlled trial in China. Eligible patients shall be randomly assigned to receive standard aspirin with tirofiban or placebo on the first day and standard aspirin from days 2 to 90. The primary endpoint is a new stroke or END within 90 days. The primary safety endpoint is severe or moderate bleeding within 90 days. DISCUSSION: The STRATEGY trial will assess whether tirofiban combined with aspirin is effective and safe in preventing recurrence and END in patients with PAI. TRIAL REGISTRATION NUMBER: NCT05310968.

A Scoping Review of Nonconsensual Condom Removal ("Stealthing") Research.

Nonconsensual condom removal (NCCR; also known as "stealthing") involves the removal of a condom before or during sexual intercourse without a partner's sexual consent. Within the past several years, nations across the globe have codified NCCR as a form of sexual violence penalized by civil and/or criminal penalties. Given the recent legal attention to this behavior, we performed a scoping review of the peer-reviewed, empirical, English-language studies conducted on NCCR in order to summarize the current state of this field of research. Our scoping review yielded 27 articles meeting study inclusion criteria. Data on NCCR victimization and perpetration prevalence rates and correlates, as well as perceptions of NCCR, were extracted. The majority of the reviewed studies were conducted within the past 5 years and pertained to NCCR victimization. Rates of NCCR victimization ranged from 7.9% to 43.0% for women and 5.0% to 19.0% for men who have sex with men; rates of NCCR perpetration ranged from 5.1% to 9.8% for men and 0% for women. NCCR correlates included sociodemographic variables, relationship type, psychological factors, and sexual health concerns. Perceptions of NCCR were largely negative. The nascent field of NCCR research provides empirical evidence from several countries regarding concerning rates of NCCR. Building upon this foundation, continued research regarding NCCR is imperative. Studies that further delineate NCCR prevalence, risk factors, and outcomes would provide critical information beneficial to the development of evidence-based prevention and intervention programs targeting reductions in NCCR.

Dual Antiplatelet Treatment up to 72 Hours after Ischemic Stroke.

BACKGROUND: Dual antiplatelet treatment has been shown to lower the risk of recurrent stroke as compared with aspirin alone when treatment is initiated early (≤24 hours) after an acute mild stroke. The effect of clopidogrel plus aspirin as compared with aspirin alone administered within 72 hours after the onset of acute cerebral ischemia from atherosclerosis has not been well studied. METHODS: In 222 hospitals in China, we conducted a double-blind, randomized, placebo-controlled, two-by-two factorial trial involving patients with mild ischemic stroke or high-risk transient ischemic attack (TIA) of presumed atherosclerotic cause who had not undergone thrombolysis or thrombectomy. Patients were randomly assigned, in a 1:1 ratio, within 72 hours after symptom onset to receive clopidogrel (300 mg on day 1 and 75 mg daily on days 2 to 90) plus aspirin (100 to 300 mg on day 1 and 100 mg daily on days 2 to 21) or matching clopidogrel placebo plus aspirin (100 to 300 mg on day 1 and 100 mg daily on days 2 to 90). There was no interaction between this component of the factorial trial design and a second part that compared immediate with delayed statin treatment (not reported here). The primary efficacy outcome was new stroke, and the primary safety outcome was moderate-to-severe bleeding - both assessed within 90 days. RESULTS: A total of 6100 patients were enrolled, with 3050 assigned to each trial group. TIA was the qualifying event for enrollment in 13.1% of the patients. A total of 12.8% of the patients were assigned to a treatment group no more than 24 hours after stroke onset, and 87.2% were assigned after 24 hours and no more than 72 hours after stroke onset. A new stroke occurred in 222 patients (7.3%) in the clopidogrel-aspirin group and in 279 (9.2%) in the aspirin group (hazard ratio, 0.79; 95% confidence interval [CI], 0.66 to 0.94; P = 0.008). Moderate-to-severe bleeding occurred in 27 patients (0.9%) in the clopidogrel-aspirin group and in 13 (0.4%) in the aspirin group (hazard ratio, 2.08; 95% CI, 1.07 to 4.04; P = 0.03). CONCLUSIONS: Among patients with mild ischemic stroke or high-risk TIA of presumed atherosclerotic cause, combined clopidogrel-aspirin therapy initiated within 72 hours after stroke onset led to a lower risk of new stroke at 90 days than aspirin therapy alone but was associated with a low but higher risk of moderate-to-severe bleeding. (Funded by the National Natural Science Foundation of China and others; INSPIRES ClinicalTrials.gov number, NCT03635749.).

Using the PEAR1 Polymorphisms Rs12041331 and Rs2768759 as Potential Predictive Markers of 90-Day Bleeding Events in the Context of Minor Strokes and Transient Ischemic Attack.

In this study, we explored the relationship between the platelet endothelial aggregation receptor 1 (PEAR1) polymorphisms, platelet reactivity, and clinical outcomes in patients with minor stroke or transient ischemic attack (TIA). Randomized controlled trial subgroups were assessed, wherein patients received dual antiplatelet therapy for at least 21 days. Platelet reactivity was measured at different time intervals. Genotypes were categorized as wild-type, mutant heterozygous, and mutant homozygous. Clinical outcomes were evaluated after 90 days. The rs12041331 polymorphism predominantly influenced adenosine diphosphate channel platelet activity, with the AA genotype displaying significantly lower residual platelet activity to the P2Y12 response unit (p < 0.01). This effect was more evident after 7 days of dual antiplatelet treatment (p = 0.016). Mutant A allele carriers had decreased rates of recurrent stroke and complex endpoint events but were more prone to bleeding (p = 0.015). The rs2768759 polymorphism majorly impacted arachidonic acid (AA) channel platelet activity, which was particularly noticeable in the C allele carriers. Our regression analysis demonstrated that rs12041331 AA + GA and rs2768759 CA predicted 90-day post-stroke bleeding. In conclusion, the PEAR1 polymorphisms rs12041331 and rs2768759 interfere with platelet aggregation and the performance of antiplatelet drugs. These genetic variations may contribute to bleeding events associated with minor stroke and TIA.

Prevalence and Risk Factors of Cerebral Small Vessel Disease from a Population-Based Cohort in China.

INTRODUCTION: Cerebral small vessel disease (CSVD) is a significant burden of morbidity and mortality among elderly people around the world. Epidemiological data with complete CSVD evaluations and a large sample size in the general population are still limited. METHODS: Community-dwelling residents in Lishui city in China from the cross-sectional survey of the Polyvascular Evaluation for Cognitive Impairment and Vascular Events (PRECISE) study were included in this study from 2017 to 2019. All participants underwent 3 Tesla brain magnetic resonance images to assess CSVD imaging markers. Demographic and risk factor data were collected. The general and age-specific prevalence of lacune, confluent white matter hyperintensity (WMH), moderate-severe enlarged perivascular spaces (EPVS), cerebral microbleed (CMB), and total CSVD score (an ordinal scale from 0 to 4, counting the presence of four imaging markers of CSVD) was evaluated. Associations between vascular risk factors and these markers were analyzed by multivariable logistic regression. RESULTS: A total of 3,063 participants were enrolled. The mean age was 61.2 years and 46.5% were men. The most prevalent CSVD marker was confluent WMH (16.7%), followed by CMB (10.2%), moderate-severe EPVS in the basal ganglia (BG-EPVS) (9.8%), and lacune (5.6%). 30.5% of the participants have at least one of the four markers (total CSVD score ≥1 points). The prevalence of CSVD markers increases as age increases. Age and hypertension were independent risk factors for four CSVD markers and the total CSVD score. CONCLUSIONS: In this Chinese cohort with community-based adults aged 50-75 years, our findings showed a prevalence of 30.5% for CSVD. The most prevalent CSVD marker was confluent WMH, followed by CMB, moderate-severe BG-EPVS, and lacune. The risk factors for CSVD must be strictly screened and controlled in adults living in the community.

Sexual Compulsivity Mediates the Association Between Childhood Sexual Abuse and Condom Use Resistance Among Men Who Have Sex with Men and Women.

Despite the continued prevalence of HIV and condoms' proven effectiveness in HIV prevention, many young men continue to engage in condom use resistance (CUR). Research shows that sexual compulsivity and childhood sexual abuse (CSA) victimization are risk factors for CUR. Given that sexual activity between men is the most common method through which HIV is transmitted, and that men who have sex with men and women (MSMW) are up to five times as likely to contract or transmit HIV as men who have sex with women only (MSWO), understanding the CUR behaviors of MSMW is uniquely important. Young, single men who had had sex with a woman in the past year (N = 623) completed questionnaires assessing their previous sexual experiences with men and women, history of CSA, sexual compulsivity, and CUR to determine how MSMW classification may moderate the associations between these variables. Results revealed full, moderated mediation, such that CSA was significantly associated with sexual compulsivity among MSMW, but not MSWO. Furthermore, sexual compulsivity was subsequently associated with CUR, in a model accounting for 5.35% of CUR variance. Such findings suggest that exposure to CSA may render MSMW especially susceptible to maladaptive, sexually compulsive desires and behaviors. As a result, MSMW may be more likely to disregard the inherent risks associated with condomless sexual activity and engage in CUR. Thus, intervention programs seeking to reduce the transmission of HIV and other STIs should prioritize targeting MSMW who experienced CSA to reduce sexual compulsivity and increase condom use.