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European Journal of Investigation in... Apr 2024Long COVID refers to the persistence or development of signs and symptoms well after the acute phase of COVID-19.
BACKGROUND
Long COVID refers to the persistence or development of signs and symptoms well after the acute phase of COVID-19.
OBJECTIVE OF THE STUDY
To investigate the long-term outcomes of the SARS-CoV-2 infection in terms of psychological, social, and relational consequences within the Italian population.
MATERIALS AND METHODS
We conducted an observational, cross-sectional, and multicenter study using an online questionnaire distributed to a sample of the Italian population. By utilizing the Short Form 12 Health Survey (SF-12) and the Hikikomori scale, we assessed perceived quality of life and social isolation, respectively. The questionnaire also included an open-answer question: "What will you remember about the pandemic period?". We used generative artificial intelligence to analyze and summarize the corresponding answers.
RESULTS
A total of 1097 people participated in this study. A total of 79.3% (n = 870) of participants declared that they had been hospitalized and 62.8% (n = 689) received home care. Physical symptoms included headaches (43%, n = 472) and asthma (30.4%, n = 334). Additionally, 29.2% (n = 320) developed an addiction during the pandemic and, among these, 224 claimed internet addiction while 73 declared an emotional addiction. Furthermore, 51.8% (n = 568) experienced limitations in carrying out daily life activities. According to the Hikikomori scale, participants with positive SARS-CoV-2 infection exhibited higher levels of isolation compared to the others ( < 0.001). Participants without COVID-19 showed higher levels of emotional support ( < 0.001). Our semiautomatic analysis of the open-ended responses, obtained by a procedure based on a free large language model, allowed us to deduce and summarize the main feelings expressed by the interviewees regarding the pandemic.
CONCLUSIONS
The data collected emphasize the urgent need to investigate the consequences of long COVID in order to implement interventions to support psychological well-being.
PubMed: 38785574
DOI: 10.3390/ejihpe14050076 -
Journal of Diabetes Jun 2024Type 2 diabetes mellitus (T2DM) is a complicated disease related to metabolism that results from resistance to insulin and sustained hyperglycemia. Traditional... (Review)
Review
Type 2 diabetes mellitus (T2DM) is a complicated disease related to metabolism that results from resistance to insulin and sustained hyperglycemia. Traditional antidiabetic drugs cannot meet the demand of different diabetes patients for reaching the glycemic targets; thus, the identification of new antidiabetic drugs is urgently needed for the treatment of T2DM to enhance glycemic control and the prognosis of patients suffering from T2DM. Recently, glucokinase (GK) has attracted much attention and is considered to be an effective antidiabetic agent. Glucokinase activators (GKA) represented by dorzagliatin could activate GK and mimic its function that triggers a counter-regulatory response to blood glucose changes. Dorzagliatin has shown great potential for glycemic control in diabetic patients in a randomized, double-blind, placebo-controlled Phase 3 trial (SEED study) and had a favorable safety profile and was well tolerated (DAWN study). In the SEED study, dorzagliatin significantly reduced glycosylated hemoglobin (HbA1c) by 1.07% and postprandial blood glucose by 2.83 mol/L, showing the great potential of this drug to control blood glucose in diabetic patients, with good safety and good tolerance. An extension of the SEED study, the DREAM study, confirmed that dorzagliatin monotherapy significantly improved 24-h glucose variability and increased time in range (TIR) to 83.7% over 46 weeks. Finally, the clinical study of dorzagliatin combined with metformin (DAWN study) confirmed that dorzagliatin could significantly reduce HbA1c by 1.02% and postprandial blood glucose by 5.45 mol/L. The current review summarizes the development of GK and GKA, as well as the prospects, trends, applications, and shortcomings of these treatments, especially future directions of clinical studies of dorzagliatin.
Topics: Humans; Diabetes Mellitus, Type 2; Hypoglycemic Agents; Glucokinase; Blood Glucose; Drug Development; Enzyme Activators; Glycated Hemoglobin
PubMed: 38783768
DOI: 10.1111/1753-0407.13563 -
Heliyon May 2024Global sustainability challenges such as climate change are linked to carbon emissions from fossil fuel powered energy needed for commercial and household consumption.... (Review)
Review
Global sustainability challenges such as climate change are linked to carbon emissions from fossil fuel powered energy needed for commercial and household consumption. South Africa is highly depended on coal for energy production hence the transition to renewable energy sources such as solar PV is seen as a pathway towards emissions reduction and a sustainable future. Yet, despite the huge potential for solar PV technologies adoption remains very low. This scoping review examines the barriers to household solar PV adoption in South Africa to advance our understanding beyond case study level studies. We analysed all published literature on household solar PV in South Africa as a basis for finding themes, gaps, and trends on solar PV research. Review results show that key barriers can be grouped into financial, personal, institutional, technical and societal barriers, however there were no studies on barriers across an income gradient, a glaring omission given debates on just transitions. Given the complexity of the barriers ranging from personal, societal, to technical barriers, it is not reasonable to expect the government to facilitate transition to solar PV alone. Rather, collective approaches are needed to create enabling conditions for solar PV adoption such as the financial means and information availability. The private sector has a key role to play either in supporting state-initiated programmes or creating the means for solar PV adoption such as power purchase agreements. That said, the state remains a central player in facilitating an enabling economic and political environment to leverage responsiveness from other actors. Without an integrated approach to addressing barriers to solar PV adoption, solar adoption will remain a source of energy for the economically privileged, and the imperative to just transition to renewable energy a pipe dream, in a country characterised by large inequalities among households.
PubMed: 38778934
DOI: 10.1016/j.heliyon.2024.e30937 -
Alzheimer's Research & Therapy May 2024Maximizing the efficiency to screen amyloid-positive individuals in asymptomatic and non-demented aged population using blood-based biomarkers is essential for future...
BACKGROUND
Maximizing the efficiency to screen amyloid-positive individuals in asymptomatic and non-demented aged population using blood-based biomarkers is essential for future success of clinical trials in the early stage of Alzheimer's disease (AD). In this study, we elucidate the utility of combination of plasma amyloid-β (Aβ)-related biomarkers and tau phosphorylated at threonine 217 (p-tau217) to predict abnormal Aβ-positron emission tomography (PET) in the preclinical and prodromal AD.
METHODS
We designed the cross-sectional study including two ethnically distinct cohorts, the Japanese trial-ready cohort for preclinica and prodromal AD (J-TRC) and the Swedish BioFINDER study. J-TRC included 474 non-demented individuals (CDR 0: 331, CDR 0.5: 143). Participants underwent plasma Aβ and p-tau217 assessments, and Aβ-PET imaging. Findings in J-TRC were replicated in the BioFINDER cohort including 177 participants (cognitively unimpaired: 114, mild cognitive impairment: 63). In both cohorts, plasma Aβ(1-42) (Aβ42) and Aβ(1-40) (Aβ40) were measured using immunoprecipitation-MALDI TOF mass spectrometry (Shimadzu), and p-tau217 was measured with an immunoassay on the Meso Scale Discovery platform (Eli Lilly).
RESULTS
Aβ-PET was abnormal in 81 participants from J-TRC and 71 participants from BioFINDER. Plasma Aβ42/Aβ40 ratio and p-tau217 individually showed moderate to high accuracies when detecting abnormal Aβ-PET scans, which were improved by combining plasma biomarkers and by including age, sex and APOE genotype in the models. In J-TRC, the highest AUCs were observed for the models combining p-tau217/Aβ42 ratio, APOE, age, sex in the whole cohort (AUC = 0.936), combining p-tau217, Aβ42/Aβ40 ratio, APOE, age, sex in the CDR 0 group (AUC = 0.948), and combining p-tau217/Aβ42 ratio, APOE, age, sex in the CDR 0.5 group (AUC = 0.955), respectively. Each subgroup results were replicated in BioFINDER, where the highest AUCs were seen for models combining p-tau217, Aβ42/40 ratio, APOE, age, sex in cognitively unimpaired (AUC = 0.938), and p-tau217/Aβ42 ratio, APOE, age, sex in mild cognitive impairment (AUC = 0.914).
CONCLUSIONS
Combination of plasma Aβ-related biomarkers and p-tau217 exhibits high performance when predicting Aβ-PET positivity. Adding basic clinical information (i.e., age, sex, APOE ε genotype) improved the prediction in preclinical AD, but not in prodromal AD. Combination of Aβ-related biomarkers and p-tau217 could be highly useful for pre-screening of participants in clinical trials of preclinical and prodromal AD.
Topics: Humans; Amyloid beta-Peptides; Female; Male; tau Proteins; Aged; Positron-Emission Tomography; Biomarkers; Cross-Sectional Studies; Brain; Aged, 80 and over; Cohort Studies; Phosphorylation; Middle Aged; Alzheimer Disease; Peptide Fragments; Cognitive Dysfunction
PubMed: 38778353
DOI: 10.1186/s13195-024-01469-w -
European Heart Journal. Case Reports May 2024Excluding spontaneous coronary artery dissection (SCAD) as an aetiology of acute coronary syndrome in young adults is imperative.
BACKGROUND
Excluding spontaneous coronary artery dissection (SCAD) as an aetiology of acute coronary syndrome in young adults is imperative.
CASE SUMMARY
A previously healthy 39-year-old woman experienced sudden severe chest pain, ST-segment elevation on electrocardiogram, necessitating high-dose aspirin and urgent transfer to a revascularization centre. Suffering ventricular tachycardia (VT) and ventricular fibrillation (VF), she underwent two rounds of advanced life support and venoarterial extracorporeal membrane oxygenation. Diagnosed with left main coronary artery (LMCA) SCAD, she was initially started on conservative therapy for declining left ventricular ejection fraction. However, she continued to experience an escalating anginal symptoms, worsening biomarkers, and LMCA SCAD progression, which urged the need for surgical intervention with coronary artery bypass graft surgery (CABG). Following her CABG, she experienced a worsening of her functional mitral regurgitating, which she underwent transcatheter edge-to-edge repair of her severe mitral regurgitation. Despite being listed for orthotopic heart transplantation (OHTx), her low body mass index and elevated antibodies necessitated the HeartMate III left ventricular assist device (LVAD) for bridge to transplant. After treating frequent VT episodes with medications, she eventually received a LVAD as a bridge to cardiac transplantation. Within 1 year of her receiving LVAD, she underwent a successful OHTx.
DISCUSSION
The pathogenesis of SCAD involves intramural haematoma formation through intimal tears or vasa vasorum haemorrhage. Adverse outcomes that could occur in SCAD patients include cardiac arrest, cardiogenic shock, reduced left ventricle systolic function, and occasionally serious cardiac arrhythmia-such as VF-which can lead to sudden cardiac death. Although most SCAD cases heal spontaneously, revascularization can be considered in case of worsening SCAD progression. Advanced therapeutic intervention including mechanical circulatory support and OHTx should be considered in refractory cases.
PubMed: 38774773
DOI: 10.1093/ehjcr/ytae234 -
European Heart Journal. Digital Health May 2024The accuracy of voice-assisted technologies, such as Amazon Alexa, to collect data in patients who are older or have heart failure (HF) is unknown. The aim of this study...
AIMS
The accuracy of voice-assisted technologies, such as Amazon Alexa, to collect data in patients who are older or have heart failure (HF) is unknown. The aim of this study is to analyse the impact of increasing age and comorbid HF, when compared with younger participants and caregivers, and how these different subgroups classify their experience using a voice-assistant device, for screening purposes.
METHODS AND RESULTS
Subgroup analysis (HF vs. caregivers and younger vs. older participants) of the VOICE-COVID-II trial, a randomized controlled study where participants were assigned with subsequent crossover to receive a SARS-CoV2 screening questionnaire by Amazon Alexa or a healthcare personnel. Overall concordance between the two methods was compared using unweighted kappa scores and percentage of agreement. From the 52 participants included, the median age was 51 (34-65) years and 21 (40%) were HF patients. The HF subgroup showed a significantly lower percentage of agreement compared with caregivers (95% vs. 99%, = 0.03), and both the HF and older subgroups tended to have lower unweighted kappa scores than their counterparts. In a post-screening survey, both the HF and older subgroups were less acquainted and found the voice-assistant device more difficult to use compared with caregivers and younger individuals.
CONCLUSION
This subgroup analysis highlights important differences in the performance of a voice-assistant-based technology in an older and comorbid HF population. Younger individuals and caregivers, serving as facilitators, have the potential to bridge the gap and enhance the integration of these technologies into clinical practice.
STUDY REGISTRATION
ClinicalTrials.gov Identifier: NCT04508972.
PubMed: 38774370
DOI: 10.1093/ehjdh/ztae012 -
Indian Journal of Ophthalmology May 2024The quest of every dedicated phaco surgeon is to develop skills to emulsify all forms of hard nuclei efficiently with minimal damage to the endothelium and reducing the...
The quest of every dedicated phaco surgeon is to develop skills to emulsify all forms of hard nuclei efficiently with minimal damage to the endothelium and reducing the risk of wound burn. Obtaining a pristine cornea the very next day in a hard cataract is a dream far from reality. Prechop means nuclear division without the use of phaco energy. In this article, we describe a prechopping technique using a new sickle-shaped (saber tooth curvature and tip) novel prechopper that has a slender, sleek, and elegant design well suited for nuclear disassembly. The novel prechopper has proved to be a wonder device for hard, soft, white, posterior polar, and exfoliation cataracts. All maneuvers of prechop are performed in the bag away from the endothelium to be easily emulsified, subsequently making phacoemulsification easier, faster, and safer.
PubMed: 38773834
DOI: 10.4103/IJO.IJO_2792_23 -
Scientific Reports May 2024Self-generated thoughts have been widely investigated in recent years, while the terms "mind-wandering" and "day-dreaming" are usually used interchangeably. But are...
Self-generated thoughts have been widely investigated in recent years, while the terms "mind-wandering" and "day-dreaming" are usually used interchangeably. But are these terms equivalent? To test this, online study participants were presented with situations of a protagonist engaged in self-generated thoughts. The scenarios differed with regard to type of situation, the activity in which the protagonist was engaged in, and the properties of the self-generated thoughts. Two different groups evaluated the same situations; one group evaluated the extent to which the protagonist mind-wandered and another the extent to which the protagonist day-dreamt. Our key findings were that the situations were perceived differently with regard to mind-wandering and day-dreaming, depending on whether self-generated thoughts occurred when the protagonist was busy with another activity and the type of self-generated thoughts. In particular, while planning, worrying, and ruminating thoughts were perceived more as mind-wandering in situations involving another activity/task, the situations without another activity/task involving recalling past events and fantasizing thoughts were perceived more as day-dreaming. In the additional experiment, we investigated laypeople's reasons for classifying the situation as mind-wandering or day-dreaming. Our results altogether indicate that mind-wandering and day-dreaming might not be fully equivalent terms.
Topics: Humans; Female; Male; Adult; Thinking; Young Adult; Attention; Adolescent; Fantasy
PubMed: 38773219
DOI: 10.1038/s41598-024-62383-7 -
Journal of Gastrointestinal Oncology Apr 2024Surgical resection of esophageal and gastroesophageal junction cancers is a very complex procedure with step learning curve. New technologies have made minimally...
BACKGROUND
Surgical resection of esophageal and gastroesophageal junction cancers is a very complex procedure with step learning curve. New technologies have made minimally invasive surgery possible, but challenges still remain for wide spread adoption of these techniques. This article aims to describe the outcomes and salient technical points of a totally minimally invasive, laparoscopic, robot-assisted Ivor Lewis esophagectomy (LRAMIE).
METHODS
Retrospective observational cohort study performed at a specialty cancer center using a prospectively maintained institutional database. Patients undergoing LRAMIE (laparoscopic abdomen, robotic chest) from 2014-2023 were included. Patients undergoing transhiatal and three-field esophagectomy were excluded. Operative and postoperative outcomes were compared over the study period to identify potential associations between outcomes over time.
RESULTS
Two-hundred patients were identified who underwent LRAMIE. Median age was 65 years and most were male (87.5%). The open conversion rate was 1% (n=2), which occurred within the first 30 cases. Operative time and blood loss were improved at the 60-case mark (P<0.001). Anastomotic stricture rate improved after 50 cases, and leak rate improved after 80 cases. Postoperative length of stay improved at both 50 and 100 cases with a median LOS of 6 days after 100 cases. Rate of postoperative pneumonia, 30- and 90-day mortality were reduced after 100 cases, although not statistically significant for mortality due to too few events.
CONCLUSIONS
Totally minimally invasive Ivor Lewis esophagectomy at a high-volume center is a safe procedure. Operative outcomes improved significantly after 50-80 cases, followed by improvement in anastomotic results and postoperative outcomes, with corresponding excellent oncologic outcomes.
PubMed: 38756649
DOI: 10.21037/jgo-23-923 -
Clinical Epigenetics May 2024Youth-onset type 2 diabetes (T2D) is physiologically distinct from adult-onset, but it is not clear how the two diseases differ at a molecular level. In utero exposure...
OBJECTIVE
Youth-onset type 2 diabetes (T2D) is physiologically distinct from adult-onset, but it is not clear how the two diseases differ at a molecular level. In utero exposure to maternal type 2 diabetes (T2D) is known to be a specific risk factor for youth-onset T2D. DNA methylation (DNAm) changes associated with T2D but which differ between youth- and adult-onset might delineate the impacts of T2D development at different ages and could also determine the contribution of exposure to in utero diabetes.
METHODS
We performed an epigenome-wide analysis of DNAm on whole blood from 218 youth with T2D and 77 normoglycemic controls from the iCARE (improving renal Complications in Adolescents with type 2 diabetes through REsearch) cohort. Associations were tested using multiple linear regression models while adjusting for maternal diabetes, sex, age, BMI, smoking status, second-hand smoking exposure, cell-type proportions and genetic ancestry.
RESULTS
We identified 3830 differentially methylated sites associated with youth T2D onset, of which 3794 were moderately (adjusted p-value < 0.05 and effect size estimate > 0.01) associated and 36 were strongly (adjusted p-value < 0.05 and effect size estimate > 0.05) associated. A total of 3725 of these sites were not previously reported in the EWAS Atlas as associated with T2D, adult obesity or youth obesity. Moreover, three CpGs associated with youth-onset T2D in the PFKFB3 gene were also associated with maternal T2D exposure (FDR < 0.05 and effect size > 0.01). This is the first study to link PFKFB3 and T2D in youth.
CONCLUSION
Our findings support that T2D in youth has different impacts on DNAm than adult-onset, and suggests that changes in DNAm could provide an important link between in utero exposure to maternal diabetes and the onset of T2D.
Topics: Humans; Diabetes Mellitus, Type 2; Female; DNA Methylation; Pregnancy; Adolescent; Male; Prenatal Exposure Delayed Effects; Epigenesis, Genetic; Age of Onset; Child; Case-Control Studies; Diabetes, Gestational; Adult; Epigenome
PubMed: 38741114
DOI: 10.1186/s13148-024-01675-1