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1.
Rev Environ Health ; 2021 Nov 18.
Artigo em Inglês | MEDLINE | ID: mdl-34796708

RESUMO

OBJECTIVES: Earlier longitudinal reviews on environmental and occupational toxins and Parkinson's disease (PD) risk have limitations. This study aimed to determine the strength of association between three types of toxic occupational exposures and the occurrence of PD by diagnostic methods. METHODS: A search was conducted of EMBASE, PubMed/Medline, Toxnet, LILACS, and Cochrane Library databases for longitudinal studies that assessed toxic occupational exposure, Parkinsonian, or related disorders, diagnosed by International Classification of Diseases (ICD) codes, medical records, or confirmation by a neurologist/nurse, and published in the English language from January 1990 to July 2021. Pooled risk ratios (RR) estimates were produced using random-effects models. Systematic review with meta-analysis synthesized the results. Study quality, heterogeneity, and publication bias were examined. High-quality articles that met the inclusion criteria were analyzed. RESULTS: Twenty-four articles were used in the analyses. The pooled RR for electromagnetic exposure and PD were (RR=1.03, 95% confidence interval [CI] 0.91-1.16) while the pooled RR between PD and metal and pesticide exposure were (RR=1.07, 95% CI 0.92-1.24) and (RR=1.41, 95% CI 1.20-1.65), respectively. Pooled RR for methods of diagnosis and their associations with PD were: confirmation by a neurologist or nurse (RR=2.17, 95% CI 1.32-3.54); ICD codes (RR=1.14, 95% CI 1.03-1.26), and medical records (RR=1.06, 95% CI 0.92-1.21). CONCLUSIONS: Our systematic review provides robust evidence that toxic occupational exposures are significant risk factors for PD especially those diagnosed by neurologists or nurses using standardized methods.

2.
Epilepsy Res ; 177: 106755, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34517272

RESUMO

OBJECTIVE: A multicenter study of phenobarbital versus valproate (i.e., the China 2-P vs. V study) was conducted to compare the efficacy and safety of phenobarbital and valproate for generalized convulsive status epilepticus (SE) in a multicenter trial design. METHODS: Three improvements (uniform intravenous pumping, pump speed adjustment according to adverse events and blood drug level monitoring) over a previous study were made regarding an intravenous regimen of phenobarbital and valproate in a multicenter, prospective, randomized, controlled study. Long-term electroencephalography (EEG) monitoring was performed after initial drug treatment. Termination, relapse, adverse event and poor prognosis rates in patients with generalized convulsive status epilepticus (GCSE) were compared. RESULTS: The rate of GCSE termination within one hour were significantly higher in the phenobarbital group (33 cases) than in the valproate group (36 cases) (84.8 % vs. 63.9 %, P = 0.048), but the rates of nontermination of EEG epileptic discharge within one hour were similar between the two groups (12.1 % vs. 8.3 %, P = 0.702). The relapse and adverse event rates were not significantly different between groups, but 3 hypoventilation events and 1 hypotension event occurred in the phenobarbital group compared to 0 in the valproate group. There were no cases of epileptiform EEG discharge relapse in the phenobarbital group, compared to 1 case in the valproate group. CONCLUSIONS: The phenobarbital regimen evaluated in this study has a higher GCSE termination rate than the valproate regimen, indicating that the former is suitable for countries, regions and individuals with limited access to new antiepileptic drugs or limited economic means.

3.
Int J Food Microbiol ; 358: 109405, 2021 Nov 16.
Artigo em Inglês | MEDLINE | ID: mdl-34563883

RESUMO

Cronobacter spp. are foodborne pathogens that can cause severe infections in neonates through contaminated powdered infant formula. Accurate and rapid pathogen identification and serotyping are crucial to limit the detrimental effects of bacterial infections, and to prevent outbreaks and sporadic infections. Conventional serotyping is tedious, laborious, and time-consuming; however, with whole-genome sequencing (WGS) becoming faster and cheaper, WGS has vast potential in routine typing and surveillance. Hence, in this study, we developed a publicly available tool, CroTrait (CronobacterTraits), for in silico species identification and O serotyping of Cronobacter isolates based on WGS data. CroTrait showed excellent performance in species identification and O serotyping when 810 genomes with known species identities and 276 genomes with known O serotype were tested. Moreover, CroTrait allows rapid prediction of new potential O serotypes. We identified 11 novel potential O serotypes of Cronobacter using CroTrait. Therefore, CroTrait is a convenient and promising tool for species identification and O serotyping of Cronobacter isolates.


Assuntos
Cronobacter sakazakii , Cronobacter , Simulação por Computador , Cronobacter/genética , Cronobacter sakazakii/genética , Humanos , Lactente , Recém-Nascido , Sorogrupo , Sorotipagem , Sequenciamento Completo do Genoma
4.
Lancet Reg Health West Pac ; 12: 100182, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34527973

RESUMO

Background: Universal screening of congenital cytomegalovirus (cCMV) infection is important for monitoring and intervention during critical stages of speech and language development. This study aimed to explore the optimal detection strategy for cCMV infection screening. Methods: Serum samples from pregnant women and saliva and urine samples from their newborns were collected for the anti-CMV IgG and CMV DNA PCR tests, respectively. The sensitivity, specificity, and predictive values as well as the likelihood ratios of 12 potential screening strategies for cCMV infection, based on tests for saliva, urine, and their combination, were evaluated. Findings: A total of 6729 pregnant women were enrolled, and the seroprevalence was 98.1%. Among 6350 newborns that were followed up, 49 were defined as having cCMV infection. In the screening test, the CMV DNA positivity rate remained similar from day 0 to day 5, increased slowly from day 6 to day 13, and became high in newborns beyond 13 days of birth. In the confirmatory testing, the positive rates increased significantly beyond day 21. For the 49 newborns with cCMV infection, the proportion of agreement between saliva and urine testing was poor. Upon evaluating alternative screening strategies, using saliva and urine screening with saliva and urine confirmation as the reference strategy, saliva screening with saliva and urine confirmation showed good diagnostic accuracy and feasibility, with sensitivity, specificity, positive predictive and negative predictive values of 85.7%, 100.0%, 100.0% and 99.9%, respectively. Interpretation: In populations with high seroprevalence, saliva screening with saliva and urine confirmation might be an alternative strategy for screening cCMV infections. The suggested timeframes for screening and confirmation are within 13 (ideally 5) and 21 (ideally 13) days of birth, respectively. Funding: National Natural Science Foundation of China, National Science and Technology Major Project of China and Merck & Co., Inc., Kenilworth, New Jersey, U.S.A.

5.
Lancet Reg Health West Pac ; 13: 100196, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34527987

RESUMO

Background: Although recent studies have suggested that naturally acquired Human papillomavirus (HPV) antibodies are partly protective against subsequent homotypic infection, the extent of protection remains indecisive. Here, we evaluate the protective effect of neutralizing and IgG antibodies simultaneously. Methods: In a cohort of 3634 women aged 18-45 years from the control arm of a phase III trial of the HPV-16/18 bivalent vaccine, participants were tested for neutralizing antibodies by pseudovirion-based neutralization assay (PBNA) and IgG antibodies by enzyme-linked immunosorbent assay (ELISA) at baseline. HPV-16/18 incident and persistent infections were identified using cervical specimens periodically collected during the 5·5 years of follow-up. The protective effects of HPV-16/18 neutralizing and IgG antibodies against homotypic infection were assessed using a Cox proportional hazard model. Findings: For the persistent infection (PI) endpoints of HPV-16/18 lasting for over 6/12 months, a prevalence of type-specific neutralizing antibodies was highly protective (6-month PI: hazard ratio (HR) = 0·16, 95% confidence interval (CI): 0·04, 0·65; 12-month PI: HR = 0·23, 95% CI: 0·06, 0·94), whereas a prevalence of IgG antibodies was associated with minor and non-significant protection (6-month PI: HR = 0·66, 95% CI: 0·40, 1·09; 12-month PI: HR = 0·66, 95% CI: 0·36, 1·20). After increasing the cut-off value to the median IgG level, the risk of 6-month PI was significantly lower in seropositive vs seronegative women (HR = 0·38, 95% CI: 0·18, 0·83). Interpretation: Naturally acquired antibodies are associated with a substantially reduced risk of subsequent homotypic infection. Funding: NSFC; The Fujian Province Health Education Joint Research Project; Xiamen Science and Technology Major Project; CIFMS; and Xiamen Innovax.

6.
J Interpers Violence ; : 8862605211043576, 2021 Sep 07.
Artigo em Inglês | MEDLINE | ID: mdl-34493096

RESUMO

Interpersonal violence around pregnancy is of increasing global public health concern affecting both women themselves and their children. The primary aim of this study is to explore and identify potential correlates of such violence and to examine maternal and birth outcomes subsequent to that violence in a nationally representative sample of urban and rural women in Canada. The data are from the Maternity Experiences Survey (MES), a Canadian population-based postcensus survey administered to 6,421 Canadian mothers in 2006. Survey participants were 15 years and older and had given birth to a singleton and continued to live with their infant at the time of the survey. The survey response rate was 78%. Multivariable logistic regression analyses were used in the analysis with adjustments made for confounding variables. The study findings indicated that living in an urban environment was associated with an increased risk of interpersonal violence experience around the time of pregnancy (OR = 1.31, 95% CI: 1.03-1.66). In addition, being aboriginal, young, unmarried, economically disadvantaged, a nonimmigrant, and having more than four pregnancies, as well as cigarette smoking, alcohol drinking and drug use before the pregnancy were correlated with interpersonal violence around pregnancy. Maternal interpersonal violence experiences were also associated with postnatal depression and stressful life events among both urban and rural mothers. However, maternal interpersonal violence experiences were only associated with preterm birth among rural mothers but not among urban mothers. The present study highlights the need to implement effective interventions for women experiencing interpersonal violence around pregnancy due to its potential impact on maternal and newborn's physical and mental health. Screening and intervention should be targeted high-risk women particularly those who are indigenous, young, unmarried, nonimmigrants, of lower socioeconomic status, and manifesting high risk health behaviors.

7.
Front Immunol ; 12: 725950, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34566983

RESUMO

Objective: To investigate the characteristics and prognosis of anti-NMDAR encephalitis with the prevalence of anti-thyroid antibodies (ATAbs). Methods: The clinical data of anti-NMDAR encephalitis patients admitted to Xuanwu Hospital from January 2012 to August 2018 was prospectively analyzed, and the patients were followed up for 24 months. Results: A total of 120 patients were enrolled, of which 34.2% (41/120) were positive for ATAbs. The antibodies were more frequent in patients with severe disease compared to the non-severe group (51.4% vs. 25.6%, P=0.008). In addition, prevalence of ATAbs correlated with a higher incidence of disturbed consciousness, autonomic dysfunction, central hypoventilation and mechanical ventilation. The ATAbs-positive patients were also more likely to receive intravenous gamma immunoglobulin and immunosuppressor compared to the ATAbs-negative cases (P=0.006; P=0.035). Although the presence of ATAbs was associated with longer hospital stays and worse prognosis at 6 months (P=0.006; P=0.038), it had no impact on long-term patient prognosis. Positive status of anti-thyroglobulin antibody was an independent risk factor for worse prognosis at 6 months [odds ratio (OR)= 3.907, 95% CI: 1.178-12.958, P=0.026]. Conclusion: ATAbs are prevalent in patients with anti-NMDAR encephalitis, especially in severe cases, and correlate with poor prognosis and impaired short-term neurological recovery.

8.
Emerg Microbes Infect ; 10(1): 1824-1831, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34392819

RESUMO

Background Congenital human cytomegalovirus (CMV) infection remains largely unrecognized and underemphasized in medical practice. This study aimed to describe the maternal CMV seroprevalence rate in early gestation and congenital CMV infection in a Chinese population. Methods This prospective cohort study was conducted in three hospitals in China from 2015 through 2018. Pregnant women were enrolled in early gestation and followed up in middle and late gestation with serological testing. CMV serostatus was determined by IgG testing in serum during early gestation. Their newborns were screened for cCMV infection by PCR testing in both saliva and urine at two time points. The cCMV prevalence, maternal seroprevalence and associated factors were analyzed. Results In China, the CMV seroprevalence was 98.11% (6602/6729, 95% CI: 97.76%-98.41%), and the cCMV prevalence was 1.32% (84/6350, 95% CI: 1.07%-1.64%). Over 98% of cCMV-positive newborns were from pregnant women who were seropositive in early gestation in China. The prevalence of cCMV infection in newborns from seropositive and seronegative pregnant women was similar (crude prevalence: 1.33% vs 0.82%, P = 1.00; estimated prevalence: 1.27% vs 1.05%, P = 0.32). Pregnant women who were under 25 years old or primiparous had a lower seroprevalence. Newborns from pregnant women under 25 years old or from twin pregnancies had a higher prevalence of cCMV infection. Conclusion in China, the cCMV prevalence was high, and the rates were similar in newborns from pregnant women who were seropositive and seronegative in early gestation. The vast majority of cCMV newborns were from seropositive mothers.Trial registration: ClinicalTrials.gov identifier: NCT02645396..

9.
Front Neurol ; 12: 709803, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34335460

RESUMO

Introduction: With a high incidence rate and low diagnosis rate, vestibular migraine (VM) can seriously affect the quality of life of patients, but it remains difficult to manage by current treatment options. Acupuncture may be a potential treatment option for VM prophylaxis, but the currently available evidence is still uncertain. Therefore, this trial aims to evaluate the efficacy and safety of acupuncture for VM prophylaxis. Methods: This is a 28-week parallel, randomized, controlled clinical trial including 4 weeks of baseline, 8 weeks of treatment, and 16 weeks of follow-up. A total of 72 participants will be randomly assigned to two groups. The participants will receive acupuncture in the experimental group, while the participants in the control group will be treated with venlafaxine. The primary outcome measures are change in vertigo/migraine days and vertigo/migraine attacks, vertigo severity, and migraine intensity per 4 weeks from baseline. The secondary outcome measures are change in doses of rescue medication, anxiety level, depression level, and quality of life per 4 weeks from baseline. Adverse events will be recorded for safety evaluation. Discussion: This study will investigate the efficacy and safety of acupuncture for VM prophylaxis. The results will contribute to determining whether acupuncture can serve as an optional treatment strategy for treating VM. Clinical Trial Registration: www.ClinicalTrials.gov, identifier: NCT0464088.

10.
Neurocrit Care ; 2021 Jul 21.
Artigo em Inglês | MEDLINE | ID: mdl-34291392

RESUMO

BACKGROUND: Our objective was to evaluate the use of event-related potentials and the middle-latency somatosensory evoked potential (MLSEP) for the prediction of awakening in coma, determine the evaluation day that evoked potentials (EPs) best predict an awakening outcome, and determine whether the mismatch negativity (MMN) combined with the MLSEP, when recorded at 7 days after coma, improved the prediction of awakening from coma. METHODS: Design prospective blinded cohort study. Setting neurointensive care unit of a university hospital. Patients 113 consecutive patients who were severely comatose, whose etiologies of coma included stroke (65 patients), hypoxic-ischemic encephalopathy (28 patients), intracranial infection (6 patients), and other (14 patients). Interventions none. Measurements we gathered Glasgow Coma Scale scores and recorded EPs for all patients who were comatose at 7, 14, and 30 days after coma onset, unless the patients returned to consciousness. The EPs examined included the MLSEP, the middle-latency auditory evoked potential, the N100, and the MMN. With telephone follow-up after 3 months, the patients were classified as awakening or nonawakening according to Glasgow Outcome Scale. RESULTS: When predicting an awakening outcome, at least the unilateral presence of the N60 had the highest sensitivity (82.7%), whereas the presence of the MMN showed the highest specificity (82.0%). The area under the receiver operating characteristic curve for the EPs were high at 7 days after coma onset. At 7 days after coma onset, the combination of the N60 and MMN offered good predictive performance for awakening (area under the receiver operating characteristic curve = 0.852, 95% confidence interval 0.765-0.940), with increased sensitivity (70.0%) and improved specificity (91.7%). CONCLUSIONS: The N60 and MMN were the strongest prognostic factors for an awakening outcome. Furthermore, at 7 days after coma onset, the combination of the N60 and MMN improved the prediction of an awakening outcome in patients who were comatose.

11.
Anim Biosci ; 2021 Jun 24.
Artigo em Inglês | MEDLINE | ID: mdl-34293839

RESUMO

Objective: The objective of this study was to determine the effects of different social ranking order (SRO) and the enrichments (perch and dust-bath) allocation (EA) on behavior of laying hens in furnished cages. Methods: A total of 4 weeks in experiment period. 216 Hy-line brown layers beak-trimmed at 1 d of age were selected randomly at 14 weeks of age from a commercial farm, and randomly divided into 36 cages with 6 hens in each cage. High enrichments (perch and dust-bath) allocation (HEA) and low enrichments (perch and dust-bath) allocation (LEA) were provided. Video observations of behavior were obtained from the focal hens between 14 and 18 weeks of age and perching, dust-bathing and other general behaviors of the hens with different social orders were measured. Results: Perching behavior of high social ranking order hens (HSR) were significantly higher than that of medium social ranking order hens (MSR), and that of the MSR were significantly higher than that of low social ranking order hens (LSR) (P < 0.01), except for lying on perch (P > 0.05). The hens in the high enrichment allocation cage (HEAC) showed more lying behavior on perch than those in the low enrichment allocation cage (LEAC) (P < 0.01). The different SRO and EA did not affect dust-bathing behavior except vertical wing-shaking behavior (P < 0.05). The LEA did not affect general behaviors (P > 0.05), except standing and preening behaviors (P < 0.01 and P < 0.05), of which the hens in the HEAC showed less standing (P < 0.01) and more preening behavior than the hens in the LEAC. Conclusion: The SRO of laying hens has a significant effect on the perching behaviors, but SRO and EA have little effect on dust-bathing and general behaviors.

12.
Acta Neurol Scand ; 144(6): 632-639, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34314015

RESUMO

OBJECTIVE: To evaluate the cognitive and neurofunctional outcomes in patients with anti-leucine-rich glioma inactivated 1 (LGI1) encephalitis. METHODS: A cohort follow-up study was performed after a median of 33 months (range 6-78) from disease onset to the last follow-up in patients diagnosed with anti-LGI1 encephalitis, to assess the neurofunctional outcomes using modified Rankin Scale (mRS), activities of daily living (ADL), neuropsychiatric inventory (NPI) and modified telephone interview for cognitive status (TICS-M). Remote symptomatic seizure and clinical relapses were also recorded. The clinical, laboratory features, and treatment responses that characterize the disability were analyzed. RESULTS: The results showed that 81 of 86 (94.2%) patients with anti-LGI1 encephalitis were successfully followed up, while eight (9.9%) died after discharge. Among the 73 survivors, clinical relapses occurred in 18 (24.7%) patients, and those with relapses were at a higher risk of developing remote symptomatic seizure (p = .019). Although 85.2% of the patients became functionally independent (mRS ≤2), the sequelae of symptomatic seizure, neuropsychiatric symptoms, and cognitive deficits were found in 11.0%, 21.9%, and 39.7% of the patients, respectively. Residual cognitive deficits primarily occurred in the elderly subjects as well as those with symptoms of memory deficit, psychiatric disorders, sleep disturbance, disturbance of consciousness at diagnosis, and higher CSF protein levels. CONCLUSIONS: Although most patients survived and became functionally independent, a subset of patients could not return to all premorbid activities. They may have clinical relapses or suffer from remote symptomatic seizure, neuropsychiatric symptoms, and cognitive impairment.

13.
Arch Virol ; 166(8): 2299-2303, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34101005

RESUMO

Nucleic acid testing and antibody testing data from 143 recovered COVID-19 patients during the convalescent phase were retrospectively analyzed. A total of 23 (16.1%) recovered patients re-tested positive for SARS-CoV-2 RNA by RT-PCR. Three months after symptom onset, 100% and 99.3% of the patients remained positive for total and IgG antibodies, and the antibody levels remained high. IgM antibodies declined rapidly, with a median time to seroconversion of 67 (95% CI: 59, 75) days after onset. Approximately 25% of patients were seronegative for IgA antibodies at three months after onset. There was no statistically significant difference in antibody kinetics between patients with and without re-positive RT-PCR results during the convalescent phase.


Assuntos
Anticorpos Antivirais/sangue , COVID-19/imunologia , Convalescença , SARS-CoV-2/imunologia , Adulto , COVID-19/diagnóstico , Teste para COVID-19 , Feminino , Humanos , Imunoglobulina A/sangue , Imunoglobulina G/sangue , Imunoglobulina M/sangue , Cinética , Masculino , Pessoa de Meia-Idade , RNA Viral/genética , Estudos Retrospectivos , SARS-CoV-2/genética , SARS-CoV-2/isolamento & purificação , Soroconversão
14.
Infect Dis Ther ; 10(3): 1567-1578, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34146254

RESUMO

OBJECTIVES: To investigate the etiology of common respiratory pathogens in children < 2 years of age hospitalized with pneumonia in Xiamen from 2014 to 2017. METHODS: The medical records of 5581 children with pneumonia were retrospectively reviewed. Direct immunofluorescent test was used for respiratory virus testing. Bacteria were detected by conventional culture method. The results of pathogen detection at admission were analyzed as well as the clinical outcomes of children. RESULTS: The burden of hospitalized children with pneumonia was highest among infants < 6 months old (58.2%). Respiratory syncytial virus (RSV) was the most common respiratory virus (26.0%) followed by parainfluenza (4.8%) and adenovirus (3.2%). Haemophilus influenzae was the most common bacteria detected (16.6%) followed by Moraxella catarrhalis (13.4%), Staphylococcus aureus (13.0%), Streptococcus pneumoniae (12.3%), Escherichia coli (5.1%) and Klebsiella pneumoniae (4.8%). Notably, RSV and K. pneumoniae were detected more frequently in severe pneumonia (35.0% and 10.9%) versus mild pneumonia (25.6% and 4.6%), with higher rates of ICU admissions, longer hospital stays and higher hospital costs compared to those infected with other respiratory pathogens. CONCLUSIONS: Among children < 2 years of age hospitalized with pneumonia in Xiamen, RSV was the most common respiratory virus, while H. influenzae and S. pneumoniae remained the predominant bacterial pathogens detected. Considering the low implementation rate of vaccines against pneumococcal and Hib pneumonia in China, there is an urgent need to increase both vaccination rates to reduce pneumococcal and Hib disease burden.

15.
J Affect Disord ; 292: 487-495, 2021 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-34146900

RESUMO

BACKGROUND: The literature identifies a strong relationship between mental health and income, but there is little research that clarifies the directional association between household income and self-perceived mental health (SPMH) overtime either at between-perso+n or within-person levels. This study investigates whether higher income predicts better SPMH overtime and poor SPMH predicts lower income overtime both at between-person or within-person levels. METHODS: Data analyzed was from the Montreal Southwest Social and Psychiatric Epidemiology Catchment Area study (ZEPSOM), a longitudinal community-based cohort. The baseline survey was conducted in 2007/8 with follow-up every two years. We traced a total of 3464 participants over a period of 8 years. To examine the associations between income and SPMH at both between-person or within-person levels, cross-lagged panel models (CLPMs) and random intercept cross-lagged panel models (RI-CLPMs) were used. Gender and age effects were examined using multiple group analyses. Complete case analyses evaluated the findings' robustness. RESULTS: At between-person levels, higher household income predicted higher SPMH, but not vice versa. These associations were stronger among men and older adults. At within-person levels, higher income did not predict higher SPMH. No significant gender- or age- group differences were observed. Complete case analyses supported the findings. LIMITATIONS: Loss to follow-up may affect the generalizability of the research findings. CONCLUSIONS: This study suggests that higher household income predicts higher SPMH at between-person levels. Policy and programs aiming at promoting mental health should focus on low-income individuals, especially men and older adults.


Assuntos
Renda , Saúde Mental , Idoso , Estudos de Coortes , Humanos , Masculino , Inquéritos e Questionários
17.
Ther Adv Med Oncol ; 13: 17588359211010939, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33995595

RESUMO

Background: China's Fujian Cervical Pilot Project (FCPP) transitioned cervical cancer screening from high-risk human papillomavirus (HR-HPV) nongenotyping to genotyping. We investigated the clinical impact of this introduction, comparing performance indicators between HR-HPV genotyping combined with cytology screening (HR-HPV genotyping period) and the previous HR-HPV nongenotyping combined with cytology screening (HR-HPV nongenotyping period). Methods: A retrospective population-based cohort study was performed using data from the FCPP for China. We obtained data for the HR-HPV nongenotyping period from 1 January 2012 to 31 December 2013, and for the HR-HPV genotyping period from 1 January 2014 to 31 December 2016. Propensity score matching was used to match women from the two periods. Multivariable Cox regression was used to assess factors associated with cervical intraepithelial neoplasia of grade 2 or worse (CIN2+). The primary outcome was the incidence of CIN2+ in women aged ⩾25 years. Performance was assessed and included consistency, reach, effectiveness, adoption, implementation and cost. Results: Compared with HR-HPV nongenotyping period, in the HR-HPV genotyping period, more CIN2+ cases were identified at the initial screening (3.06% versus 2.32%; p < 0.001); the rate of colposcopy referral was higher (10.87% versus 6.64%; p < 0.001); and the hazard ratio of CIN2+ diagnosis was 1.64 (95% confidence interval, 1.43-1.88; p < 0.001) after controlling for health insurance status and age. The total costs of the first round of screening (US$66,609 versus US$65,226; p = 0.293) were similar during the two periods. Higher screening coverage (25.95% versus 25.19%; p = 0.007), higher compliance with age recommendations (92.70% versus 91.69%; p = 0.001), lower over-screening (4.92% versus 10.15%; p < 0.001), and reduced unqualified samples (cytology: 1.48% versus 1.73%, p = 0.099; HR-HPV: 0.57% versus 1.34%, p < 0.001) were observed in the HR-HPV genotyping period. Conclusions: Introduction of an HR-HPV genotyping assay in China could detect more CIN2+ lesions at earlier stages and improve programmatic indicators. Evidence suggests that the introduction of HR-HPV genotyping is likely to accelerate the elimination of cervical cancer in China.

18.
Mult Scler Relat Disord ; 52: 103020, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34034214

RESUMO

BACKGROUND: The co-existence of anti-N-methyl-D-aspartate receptor encephalitis (NMDARe) and anti-myelin oligodendrocyte glycoprotein (MOG) antibody disease has sparsely been reported, which needs to be investigated. METHOD: Among the patients with NMDARe in Xuanwu Hospital, MOG antibody disease and NMDARe overlapping syndrome (MNOS) were retrospectively identified. We combined our data with those from previously reported cases to characterize this new entity. RESULT: There were 45 patients with MNOS with a median onset age of 20. A total of 97.8% of the patients had symptoms of encephalitis; 68.9% of the patients had symptoms of demyelination, including optic neuritis (ON) (37.9%), longitudinally extensive transverse myelitis (LETM) (31.0%) and acute disseminated encephalomyelitis (ADEM) (27.6%). Abnormal signals on magnetic resonance imaging (MRI) usually involved cortical (46.7%), subcortical (31.1%) and basal ganglia (26.7%) lesions, as well as infratentorial (48.9%) and spinal cord (28.9%) lesions. No tumours were found. A total of 62.2% of the patients relapsed, with recurrence rates of 66.7% and 50.0% for those treated with first-line therapy alone and in combination with second-line immunotherapy, respectively. The pathological changes from the biopsy indicated immune-mediated inflammatory demyelination. Although some patients may have residual deficits, 93.3% of the patients became functionally independent. CONCLUSION: The possibility of MNOS should be considered when patients diagnosed with anti-NMDARe simultaneously or sequentially develop ON, LETM or ADEM. MNOS occurred without tumour association, and inflammatory demyelination may be the pathological change. Steroids combined with second-line immunotherapy can help to reduce high recurrence rates, and most patients will have substantial recovery.


Assuntos
Encefalite Antirreceptor de N-Metil-D-Aspartato , Encefalomielite Aguda Disseminada , Autoanticorpos , Humanos , Glicoproteína Mielina-Oligodendrócito , Recidiva Local de Neoplasia , Estudos Retrospectivos
19.
J Affect Disord ; 290: 219-226, 2021 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-34004404

RESUMO

BACKGROUND: Physical inactivity exacerbates poorer sleep quality, but potential underlying mechanisms of this association remain unknown. The present study aims to disentangle the pathways linking psychical activity to sleep quality through the serial mediation effect of anxiety and depression in a Chinese population. METHODS: Data analyzed were from Guangdong Sleep and Psychosomatic Health Survey, a cross-sectional population-based study with a representative sample of adult inhabitants aged 18-85 years living in Guangdong province, China. A total of 13,768 participants were included with the response rate of 80.4%. Singe and serial mediation analyses were conducted to examine whether anxiety and depression mediated the relationship between physical activity and sleep quality, independently and jointly. RESULTS: Both direct and indirect effects of physical activity on sleep quality were found. As predicted, anxiety and depression mediated the relationship between physical activity and sleep quality (B Anxiety = -0.17, 95% bootstrap CI: -0.20 to -0.15; B Depression= -0.25, 95% bootstrap CI: -0.28 to -0.21), respectively. In addition, serial mediation analyses indicated that the association of physical activity and sleep quality is mediated by anxiety and depression in a sequential manner (B = -0.13, 95% bootstrap CI: -0.15 to -0.11). LIMITATIONS: The primary limitation of the study is the cross-sectional design, which limits the causal inference ability. CONCLUSIONS: These findings highlight the role of anxiety and depression as serial mediators of the relationship between physical activity and sleep quality. Thus, exercise-based programs focusing on improving sleep could benefit from a multi-faceted approach therapeutically targeting psychiatric disorders.


Assuntos
Depressão , Transtornos do Sono-Vigília , Adulto , Ansiedade/epidemiologia , Transtornos de Ansiedade/epidemiologia , China/epidemiologia , Estudos Transversais , Depressão/epidemiologia , Exercício Físico , Humanos , Sono
20.
mSystems ; 6(2)2021 Apr 06.
Artigo em Inglês | MEDLINE | ID: mdl-33824201

RESUMO

Weaning of piglets is accompanied by intestinal inflammation, impaired intestinal barrier function, and intestinal microflora disorder. Regulating intestinal microflora structure can directly or indirectly affect intestinal health and host growth and development. However, whether dietary fiber (DF) affects the inflammatory response and barrier function by affecting the intestinal microflora and its metabolites is unclear. In this study, we investigated the role of intestinal microflora in relieving immune stress and maintaining homeostasis using piglets with lipopolysaccharide (LPS)-induced intestinal injury as a model. DF improved intestinal morphology and barrier function, inhibited the expression of inflammatory signal pathways (Toll-like receptor 2 [TLR2], TLR4, and NF-κB) and proinflammatory cytokines (interleukin 1ß [IL-1ß], IL-6, and tumor necrosis factor alpha [TNF-α]), and upregulated the expression of barrier-related genes (encoding claudin-1, occludin, and ZO-1). The contents of proinflammatory cytokines (IL-1ß, IL-6, and TNF-α) and the activity of diamine oxidase in plasma were decreased. Meanwhile, DF had a strong effect on the composition and function of intestinal microflora at different taxonomic levels, the relative abundances of cellulolytic bacteria and anti-inflammatory bacteria were increased, and the concentrations of propionate, butyrate, and total short-chain fatty acids (SCFAs) in intestinal contents were increased. In addition, the correlation analysis also revealed the potential relationship between metabolites and certain intestinal microflora, as well as the relationship between metabolites and intestinal morphology, intestinal gene expression, and plasma cytokine levels. These results indicate that DF improves intestinal barrier function, in part, by altering intestinal microbiota composition and increasing the synthesis of SCFAs, which subsequently alleviate local and systemic inflammation.IMPORTANCE Adding DF to the diet of LPS-challenged piglets alleviated intestinal and systemic inflammation, improved intestinal barrier function, and ultimately alleviated the growth retardation of piglets. In addition, the addition of DF significantly increased the relative abundance of SCFA-producing bacteria and the production of SCFAs. We believe that the improvement of growth performance of piglets with LPS-induced injury can be attributed to the beneficial effects of DF on intestinal microflora and SCFAs, which reduced the inflammatory response in piglets, improving intestinal barrier function and enhancing body health. These research results provide a theoretical basis and guidance for the use of specific fiber sources in the diet to improve intestinal health and growth performance of piglets and thus alleviate weaning stress. Our data also provide insights for studying the role of DF in regulating gastrointestinal function in human infants.

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