Trends in fetal and neonatal outcomes during the COVID-19 pandemic in Alabama.

BACKGROUND: The current study evaluated the hypothesis that the COVID-19 pandemic is associated with higher stillbirth but lower neonatal mortality rates. METHODS: We compared three epochs: baseline (2016-2019, January-December, weeks 1-52, and 2020, January-February, weeks 1-8), initial pandemic (2020, March-December, weeks 9-52, and 2021, January-June, weeks 1-26), and delta pandemic (2021, July-September, weeks 27-39) periods, using Alabama Department of Public Health database including deliveries with stillbirths ≥20 weeks or live births ≥22 weeks gestation. The primary outcomes were stillbirth and neonatal mortality rates. RESULTS: A total of 325,036 deliveries were included (236,481 from baseline, 74,076 from initial pandemic, and 14,479 from delta pandemic period). The neonatal mortality rate was lower in the pandemic periods (4.4 to 3.5 and 3.6/1000 live births, in the baseline, initial, and delta pandemic periods, respectively, p < 0.01), but the stillbirth rate did not differ (9 to 8.5 and 8.6/1000 births, p = 0.41). On interrupted time-series analyses, there were no significant changes in either stillbirth (p = 0.11 for baseline vs. initial pandemic period, and p = 0.67 for baseline vs. delta pandemic period) or neonatal mortality rates (p = 0.28 and 0.89, respectively). CONCLUSIONS: The COVID-19 pandemic periods were not associated with a significant change in stillbirth and neonatal mortality rates compared to the baseline period. IMPACT: The COVID-19 pandemic could have resulted in changes in fetal and neonatal outcomes. However, only a few population-based studies have compared the risk of fetal and neonatal mortality in the pandemic period to the baseline period. This population-based study identifies the changes in fetal and neonatal outcomes during the initial and delta COVID-19 pandemic period as compared to the baseline period. The current study shows that stillbirth and neonatal mortality rates were not significantly different in the initial and delta COVID-19 pandemic periods as compared to the baseline period.

Combined blood pressure and heart rate trajectories are associated with prognosis in critically ill patients with acute aortic dissection: A group-based multi-trajectory analysis.

Background: Managing systolic blood pressure (SBP), diastolic blood pressure (DBP), and heart rate (HR) is pivotal in acute aortic dissection (AAD) care. However, no prior studies have jointly analyzed the trajectories of these parameters. This research aimed to characterize their joint longitudinal trajectories and investigate the influence on AAD prognosis. Methods: We included AAD patients from the Medical Information Mart for Intensive Care (MIMIC)-IV database. Using group-based multi-trajectory modeling (GBMTM), we identified combined trajectories of SBP, DBP, and HR within the initial 24 h of intensive care unit (ICU) admission. Cox proportional hazard regression, log-binomial regression, and logistic regression were employed to assess the association between trajectory groups and mortality outcomes. Results: Data from 337 patients were analyzed. GBMTM identified five combined trajectory groups. Group 1 featured rapidly declining SBP and DBP with high pulse pressure and low HR; Group 2 showed high to moderate SBP with slight rebound and persistently low HR; Group 3 displayed persistently moderate BP and HR; Group 4 was characterized by moderate blood pressure with persistently high HR; and Group 5 had high to moderate SBP with slight rebound, high but gradually declining DBP, and slightly high HR. Group 3 demonstrated a lower risk of mortality, with an adjusted hazard ratio of 0.32 (95 % CI, 0.14-0.74), and the adjusted relative risks for in-hospital, 30-day, and 1-year mortalities were 0.37 (95 % CI, 0.15-0.87), 0.25 (95 % CI, 0.10-0.62), and 0.41 (95 % CI, 0.22-0.79), respectively. The time-independent C-index curve demonstrated that the multi-trajectory groups had higher C-index values than any univariate trajectory groups or admission values of SBP, DBP, and HR. Conclusions: Utilization of GBMTM can yield data-driven insights to identify distinct subphenotypes in AAD patients. The combined trajectories of SBP, DBP, and HR within 24 h of ICU admission significantly influenced the mortality rate.

Prognostic implications of thyroid hormones in acute aortic dissection: mediating roles of renal function and coagulation.

Background: Thyroid hormones significantly influence cardiovascular pathophysiology, yet their prognostic role in acute aortic dissection (AAD) remains inadequately explored. This study assesses the prognostic value of thyroid hormone levels in AAD, focusing on the mediating roles of renal function and coagulation. Methods: We included 964 AAD patients in this retrospective cohort study. Utilizing logistic regression, restricted cubic splines, and causal mediation analysis, we investigated the association between thyroid hormones and in-hospital mortality and major adverse cardiovascular events (MACEs). Results: In AAD patients overall, an increase of one standard deviation in FT4 levels was associated with a 31.9% increased risk of MACEs (OR 1.319; 95% CI 1.098-1.584) and a 36.1% increase in in-hospital mortality (OR 1.361; 95% CI 1.095-1.690). Conversely, a higher FT3/FT4 ratio was correlated with a 20.2% reduction in risk of MACEs (OR 0.798; 95% CI 0.637-0.999). This correlation was statistically significant predominantly in Type A AAD, while it did not hold statistical significance in Type B AAD. Key renal and coagulation biomarkers, including blood urea nitrogen, creatinine, cystatin C, prothrombin time ratio, prothrombin time, and prothrombin time international normalized ratio, were identified as significant mediators in the interplay between thyroid hormones and MACEs. The FT3/FT4 ratio exerted its prognostic influence primarily through the mediation of renal functions and coagulation, while FT4 levels predominantly impacted outcomes via a partial mediation effect on coagulation. Conclusion: FT4 levels and the FT3/FT4 ratio are crucial prognostic biomarkers in AAD patients. Renal function and coagulation mediate the association between the thyroid hormones and MACEs.

GLP-1 RAs and SGLT-2 Inhibitors for Insulin Resistance in Nonalcoholic Fatty Liver Disease: Systematic Review and Network Meta-Analysis.

Objective: Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) and sodium-glucose cotransporter-2 (SGLT-2) inhibitors reduce glycaemia and weight and improve insulin resistance (IR) via different mechanisms. We aim to evaluate and compare the ability of GLP-1 RAs and SGLT-2 inhibitors to ameliorate the IR of nonalcoholic fatty liver disease (NAFLD) patients. Data Synthesis: Three electronic databases (Medline, Embase, PubMed) were searched from inception until March 2021. We selected randomized controlled trials comparing GLP-1 RAs and SGLT-2 inhibitors with control in adult NAFLD patients with or without T2DM. Network meta-analyses were performed using fixed and random effect models, and the mean difference (MD) with corresponding 95% confidence intervals (CI) were determined. The within-study risk of bias was assessed with the Cochrane collaborative risk assessment tool RoB. Results: 25 studies with 1595 patients were included in this network meta-analysis. Among them, there were 448 patients, in 6 studies, who were not comorbid with T2DM. Following a mean treatment duration of 28.86 weeks, compared with the control group, GLP-1 RAs decreased the HOMA-IR (MD [95%CI]; -1.573[-2.523 to -0.495]), visceral fat (-0.637[-0.992 to -0.284]), weight (-2.394[-4.625 to -0.164]), fasting blood sugar (-0.662[-1.377 to -0.021]) and triglyceride (- 0.610[-1.056 to -0.188]). On the basis of existing studies, SGLT-2 inhibitors showed no statistically significant improvement in the above indicators. Compared with SGLT-2 inhibitors, GLP-1 RAs decreased visceral fat (-0.560[-0.961 to -0.131]) and triglyceride (-0.607[-1.095 to -0.117]) significantly. Conclusions: GLP-1 RAs effectively improve IR in NAFLD, whereas SGLT-2 inhibitors show no apparent effect. Systematic Review Registration: PROSPERO https://www.crd.york.ac.uk/PROSPERO/, CRD42021251704.

Therapeutic effect of thalidomide combined with temozolomide and three-dimensional conformal radiotherapy for patients with high-grade gliomas after operation.

PURPOSE: To explore the efficacy and safety of 125 I radioactive seed implantation combined with intermittent hormonal therapy (IHT) in the clinical treatment of moderate- and high-risk non-metastatic prostate cancer. METHODS: A total of 136 patients were divided into the observation group (n=68) and the control group (n=68). In the observation group, 125I radioactive seed implantation was performed, bicalutamide capsules were taken orally immediately after operation, and leuprorelin was injected from 1 week after operation. In the control group, IHT alone was administered. The level of serum prostate specific antigen (PSA), maximum urine flow rate (Q max ) and international prostate symptom scale (IPSS) score were compared between the two groups before and after treatment. Moreover, the overall survival (OS), tumor-specific survival (TSS), distant metastasis-free survival (DMFS) and progression-free survival (PFS) of patients were recorded. RESULTS: There were no statistically significant differences in the PSA level, Q max and IPSS score between the two groups before treatment (p>0.05). At 6, 12 and 24 months after treatment, the level of PSA in the observation group was significantly lower than in the control group (p=0.005, p<0.001, p<0.001). At 24 months after treatment, Q max in the observation group was significantly higher than in the control group (p=0.025). At 12 and 24 months after treatment, the IPSS score in the observation group was significantly lower than that in the control group (p=0.013, p=0.002). During the follow-up period, the intermission time of hormonal therapy and PFS time in the observation group were obviously longer than those in control group (p<0.001). In the two groups, OS was 97.1% and 94.1%, TSS was 95.6% and 92.6%, DMFS was 82.4% and 66.2%, and PFS was 72.1% and 51.5%, respectively. It can be seen that OS and TSS had no statistically significant differences between the two groups (p=0.405, p=0.496), while DMFS and PFS in the observation group were remarkably superior to those in the control group (p=0.037, p=0.022). CONCLUSIONS: 125 I seed implantation combined with IHT is safe and effective in the clinical treatment of patients with moderate- and high-risk non-metastatic prostate cancer. Compared with the IHT alone, the combination therapy can significantly prolong the intermission time of hormonal therapy and effectively control the progression of disease.

Therapeutic effect of thalidomide combined with temozolomide and three-dimensional conformal radiotherapy for patients with high-grade gliomas after operation.

PURPOSE: Purpose: To investigate the clinical therapeutic effect and safety of thalidomide combined with temozolomide (TMZ) and three-dimensional conformal radiotherapy for patients with high-grade gliomas after operation. METHODS: Methods: The clinical data of 108 patients with high-grade gliomas undergoing operation in our hospital from September 2014 to December 2016 were retrospectively analyzed, of which 54 received thalidomide combined with TMZ and three-dimensional conformal radiotherapy (thalidomide group) and 54 received TMZ combined with three-dimensional conformal radiotherapy (control group). The clinical data of all patients were collected, and the short-term therapeutic effect, adverse reactions after treatment and quality of life scores were compared between the two groups of patients. Thereafter, the level of serum immune factors of the patients was recorded, and the overall survival (OS) rate and progression-free survival (PFS) rate of the patients were followed up and recorded. RESULTS: Results: The therapeutic effect was evaluated in all the patients at 1 month after treatment. It was found that the overall response rate (ORR) in thalidomide group [68.5% (37/54)] was markedly higher than that in control group [44.4% (24/54)] (p=0.012), but the difference in the disease control rate (DCR) between thalidomide group [92.6% (50/54)] and control group [83.3% (45/54)] was not statistically significant (p=0.139). After treatment, the scores of 36-Item Short Form Health Survey (SF-36) evaluating the quality of life in thalidomide group were higher than that in control group, in which the physical function score was statistically significantly different between the two groups (p=0.028), whereas the scores of the other items did not statistically significantly differ between the two groups (p>0.05). Following treatment, the levels of serum hepatocyte growth factor (HGF), tumor necrosis factor-alpha (TNF-α), interleukin (IL)-6, IL-17, vascular endothelial growth factor (VEGF) and epidermal growth factor (EGF) were remarkably reduced in the two groups of patients, and these indexes in thalidomide group were lower than those in control group after treatment. Among them, HGF (p=0.069), TNF-α (p=0.076), IL-6 (p=0.149) and IL-17 (p=0.114) showed no statistically significant differences, but VEGF and EGF were statistically significantly different between the two groups (p<0.001). Moreover, adverse reactions were mainly manifested as myelosuppression, nausea and vomiting, constipation, liver function injury, drowsiness and neurotoxicity (grade I-II in most cases), which returned to normal after symptomatic treatment. Besides, the incidence rate of drowsiness of the patients in thalidomide group was notably lower than that in control group (p=0.029), but the difference in the incidence rate of other manifestations was not statistically significant (p>0.05). Additionally, the follow-up results manifested that the median OS was (16.1±3.6) months, (12.8±3.9) months, respectively, and the median PFS was (9.0±3.2) months and (12.3±3.4) months, respectively, in thalidomide group and control group. Furthermore, log-rank test revealed that the patients in thalidomide group had longer OS (p=0.025) and PFS (p=0.040) than those in control group. CONCLUSIONS: Conclusions: The application of thalidomide combined with TMZ and three-dimensional conformal radiotherapy for high-grade glioma patients after operation can prominently enhance the clinical therapeutic effect, improve patient quality of life, prolong survival, and produce tolerable adverse reactions.

Association and relative importance of multiple obesity measures with bone mineral density: the National Health and Nutrition Examination Survey 2005-2006.

UNLABELLED: All obesity measures were positively associated with femoral neck bone mineral density (BMD), but not with lumbar spine BMD. Hip circumference was the most important obesity measure in relation to BMD. PURPOSE: Multiple measures are used to quantify obesity; different obesity measures have diverse relationship with BMD. Which obesity measure has the most important value in relation to BMD is still poorly understood. We examined the association between multiple obesity measures and BMD and determined the relative importance (RI, percentage of variation) of multiple obesity measures associated with BMD. METHODS: Data from 5287 men and women aged between 8 and 69 years (mean age = 29 years) in the National Health and Nutrition Examination Survey 2005-2006 were analyzed. Body mass index (BMI), waist circumference, hip circumference, body fat mass (FM) index, total body FM, abdominal FM, and appendicular FM were considered the exposures and femoral neck and lumbar spine BMD the outcomes. RESULTS: In the multivariable analysis, greater BMI and hip circumference were associated with increased BMD at the lumbar spine and femoral neck (all P < 0.001). The remaining obesity variables were positively associated with increased femoral neck BMD only (all P < 0.001). RI of all obesity measures associated with femoral neck BMD was much greater than that associated with lumbar spine BMD. Moreover, hip circumference had higher RI (19.8 for femoral neck BMD; 7.0 for lumbar spine BMD) than other obesity measures (all RIs ≤14.1 for femoral neck BMD; all RIs ≤3.5 for lumbar spine BMD) in relation to BMD. CONCLUSIONS: All obesity measures were positively associated with femoral neck BMD, but not with lumbar spine BMD. Hip circumference was the most important obesity measure in relation to BMD.

The application of the grey disaster model to forecast epidemic peaks of typhoid and paratyphoid fever in China.

OBJECTIVE: The objectives of this study were to forecast epidemic peaks of typhoid and paratyphoid fever in China using the grey disaster model, to evaluate its feasibility of predicting the epidemic tendency of notifiable diseases. METHODS: According to epidemiological features, the GM(1,1) model and DGM model were used to build the grey disaster model based on the incidence data of typhoid and paratyphoid fever collected from the China Health Statistical Yearbook. Model fitting accuracy test was used to evaluate the performance of these two models. Then, the next catastrophe date was predicted by the better model. RESULTS: The simulation results showed that DGM model was better than GM(1,1) model in our data set. Using the DGM model, we predicted the next epidemic peak time will occur between 2023 to 2025. CONCLUSION: The grey disaster model can predict the typhoid and paratyphoid fever epidemic time precisely, which may provide valuable information for disease prevention and control.