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The association between labor epidural analgesia and early-onset postpartum hypertension among parturients with hypertensive disorders of pregnancy: A retrospective cohort study
Background This study aimed to investigate the association of different durations of labor epidural analgesia (LEA) on early-onset postpartum hypertension (PPHTN) among parturients with hypertensive disorders of pregnancy (HDP). Methods We conducted a retrospective cohort study in which patients who were diagnosed with hypertensive disorders of pregnancy between 2018 and 2023. The parturients who received LEA were divided into three groups based on the tertiles of LEA duration: the short-duration group (< 175 minutes), the medium-duration group (175–324 minutes), and the long-duration group (≥ 325 minutes), while parturients who did not receive LEA forming the control group. The primary outcome was early-onset PPTHN, defined as the occurrence of at least one blood pressure measurement meeting hypertensive criteria within 2 days following delivery. Three multivariate logistic regression models was employed to explore the association between the duration of LEA exposure and early-onset PPHTN. Four sets of sensitivity analyses were conducted to assess the robustness of the analysis. Results In the study cohort of 1,316 parturients, 36.0% (n = 474) were diagnosed with early-onset PPHTN. Compared with those who did not receive LEA, parturients who received long-exposure LEA had significantly lower incidences of early-onset PPHTN (29.5% vs 41.7%, P < 0.05). Univariate survival analysis demonstrated that long-duration LEA was associated with a lower risk of PPHTN during hospitalization (HR = 0.75, 95% CI: 0.59–0.95, P < 0.05). All three models showed long-exposure LEA exposure was associated with a reduced incidence of early-onset PPHTN among parturients with HDP. Consistent results were observed in the sensitivity analysis conducted among parturients with documented antepartum hypertension who received multiple antihypertensive medications during pregnancy, as well as among those who did not require antihypertensive therapy during the postpartum period. However, this association did not reach statistical significance when the follow-up period was extended to five days postpartum, or in subgroups of parturients with advanced maternal age, obesity, or PE. Conclusion A longer duration of LEA was associated with a reduced risk of early-onset PPHTN among women with HDP. However, this association did not reach statistical significance in subgroups of parturients with advanced maternal age, obesity, or PE.
Evaluation of commercially available class A water-based foam concentrates for swine depopulation
Currently, the swine industry is lacking an efficient method for large-scale emergency depopulation. Class A water-based foam (WBF) has been demonstrated as a viable option for large-scale depopulation of pigs in all stages of development. However, these studies exclusively used the PHOS-CHEK WD881 (WD881) Class A foam concentrate based on previously demonstrated efficacy for depopulation. This study investigated the suitability of 15 other commercially available WBF concentrates for depopulation based on foaming performance, physiological effects, and efficacy. The performance of each product was evaluated and compared to WD881 at 0.5, 1.0 and 3.0% water-foam concentrations for low- and high-pressure pump systems. The time to fill an 11.5 m3 construction container and decay rate over a 10-minute dwell time were assessed for each WBF. Top-performing foams were further evaluated for behavior and short-term physiological changes and gross lesions during a 15-minute exposure test on piglets. Finally, the top-performing foams were tested for their suitability to depopulate adult swine during large-scale field conditions. Subcutaneous dataloggers recorded swine activity which was used to estimate the time to cessation of movement (COM), an approximate analog for loss of consciousness. Four WBF concentrates (FireIce Polar EcoFoam, Buckeye Platinum, National Foams Knockdown and BioFor N) were shortlisted based on performance at 1% concentration. These products had a mean (±SD) fill time of 62.4s (± 14.9) and decay rate of 0.5 (± 0.66) cm/min compared to WD881 with 50.0s (± 3.5) and 0.2 (± 0.1) cm/min, respectively. No differences between treatment groups were observed during the exposure testing and subsequent necropsy. For the large-scale field trials, the mean (±SE) time to COM was 151.5 s (±10.5). All foams achieved 100% mortality of swine. This study identified four additional WBFs suitable for swine depopulation which are commercially available on the U.S market. These additional WBF options may facilitate large-scale swine depopulation during widespread infectious disease outbreaks by mitigating potential bottlenecks resulting from product availability.
Characterization of experimental cerebral malaria by volumetric MRI A comparative study across the sexes
Cerebral malaria (CM), a potentially lethal neurological complication of the infection by Plasmodium falciparum, affects mostly the pediatric population under 5 years old in sub-Saharan Africa. This clinical syndrome is characterized on anatomical brain imaging by microhemorrhages, parenchymal lesions and brain edema. Epidemiological studies based on sex or gender are rare and do not allow to draw any conclusions on a possible sexual dimorphism in CM. However, some regional data and genetic studies suggest a possible influence of sex on the susceptibility to this clinical syndrome and complications in surviving patients. The murine model of experimental cerebral malaria (ECM) in mice has proven to be a useful and reliable tool to study the pathogenic mechanisms and possible therapeutical approaches for CM. In this study, we used in vivo magnetic resonance imaging (MRI) to assess the differences linked to sex in the development of experimental CM in C57BL/6J mice infected with the murine parasite Plasmodium berghei ANKA. Our volumetric analysis reveals sex-dependent differences in brain swelling and lesion distribution, particularly microhemorrhages, as well as a regionalization of brain edema in ECM, with swelling-prone structures common to both sexes like the cortex and the pons, and others which show sex-specific alterations like the inferior and superior colliculi or the midbrain. Together, our results indicate that ECM is more severe in male than in female C57Bl/6J mice.
Microbial diversity in drug-naïve Parkinson’s disease patients
Parkinson’s disease (PD) is a neurological disorder characterized by rigidity, bradykinesia and tremor. Several genetic and environmental causes of PD are known, and there is emerging evidence of the possible contribution of the gut microbiome to the disease onset, severity, and response to therapy. While previous research has shown several differences in the microbiome of PD patients under therapy as opposed to healthy controls, few prospective studies have included drug-naïve patients. In order to evaluate the gut microbiome composition prior to therapy initiation, we collected and performed 16S rRNA gene sequencing of the stool samples from 49 drug-naïve PD patients and compared them to 34 diet and lifestyle-matched controls from the Croatian population (GiOPARK Project). While no significant alpha diversity difference was observed between the patients and controls, the differential relative abundance analysis showed an increase in Bacteroides fluxus, B. interstinalis, B. eggerthii, and Dielma fastidiosa in the drug-naïve PD patients compared to controls, while Alistipes, Barnesiella and Dialister spp. were decreased in patients compared to controls. Despite preserved overall diversity, these changes may indicate early microbial dysbiosis and represent a foundation for future studies exploring microbiome changes across disease progression and treatment.
Impact of gaseous ozone treatment of fish carcasses (Gadus morhua) on the microbiological load and their quality
The improvement of the microbial quality of food products is one of the most important aspects of the world economy with a significant impact on the health of consumers. Due to the content of lipids, water, and proteins, meat is highly susceptible to degradation mediated by enzymes or microorganisms. Among the wide variety of animal-derived consumption products, fish is highly perishable and characterized by a short shelf life. To improve safety and microbial quality during storage, fish food can be treated with ozone, which is a highly potent antimicrobial agent. In this study, the effect of ozone treatment on the total microorganism content and the quality of fish food was investigated with respect to the content of lipids and the volatile faction responsible for the characteristic odour. The content of microorganisms in fish food subjected to an atmosphere enriched with ozone was reduced. For example, for the control sample with 1.8 x 103 cfu, which was exposed to 20 ppm ozone in atmosphere during the exposition time in the range 10–30 min, a microbial load was reduced to a level between 1.6 x 103 and 1.2 x 103 cfu. The observed reduction levels indicated that such an ozone treatment procedure can be declared as an viable option for improvement of microbial safety of fish. However, the presence of ozone caused qualitative changes of chemical parameters of the fish matrix; in particular, oxidation of lipids occurred. The extent of those changes increased with the extension of the exposition time..
Non-linear association between neutrophil-to-lymphocyte ratio and 90-day mortality in patients with pneumonia receiving glucocorticoids alone or in combination with other immunosuppressants: A retrospective cohort study
Objective The relationship between neutrophil-to-lymphocyte ratio (NLR) and 90-day mortality in patients with pneumonia receiving glucocorticoids alone or in combination with other immunosuppressants has not been fully verified. We aimed to explore the influence of NLR on 90-day mortality in this specific population. Methods This study utilized the data set from the Dryad database, involving 696 participants diagnosed with pneumonia who were receiving glucocorticoids alone or in combination with other immunosuppressants. Data on demographics, vital signs, laboratory results, and comorbidities were collected to assess the link between NLR and 90-day mortality. Multivariable Cox hazard regression analyses and smooth curve fitting were employed to assess the independent association between NLR and 90-day mortality. A two-piecewise linear regression model was used to examine the nonlinear association between NLR and in-hospital mortality. Receiver-operating characteristic curves (ROC) and area under the curves (AUC) were used to assess the ability of different biomarkers to predict the 90-day mortality in patients with pneumonia. Results In total, 696 patients with pneumonia were included in this study. There were 332 individuals (47.7%) aged 18–59 years and 364 (52.3%) aged 60–99 years; 52.6% were male. The 90-day mortality rate across the study population was 26.1%. A non-linear association was noted between NLR and 90-day mortality, with an inflection point at approximately 16.475. On the left side of the inflection point, the hazard ratio was 1.145(95% confidence interval [CI]: 1.091–1.2, p < 0.001). On the right side of the inflection point, the hazard ratio was 1.0057(95% CI:0.9923–1.0192; p = 0.406), reflecting a lack of statistical significance. Similar patterns were observed in subgroup analyses, with significant interaction effects noted for age and smoking status. Furthermore, the ROC curve analysis revealed that NLR was the optimal biomarker for predicting the 90-day mortality with an AUC of 0.714 (95% CI:0.670–0.757). Using 9.34 as the cutoff value of NLR, the sensitivity was 69.8%, and the specificity was 67.7%. Conclusions A nonlinear correlation between NLR and 90-day mortality was identified in pneumonia patients undergoing glucocorticoid treatment. The NLR value of 16.475 represented the optimal threshold for predicting the 90-day mortality, after exceeding the threshold,90-day mortality tended to stabilize. The findings suggest that NLR is a practical and useful biomarker for predicting the 90-day mortality in this population.
Estimation of the heritability of medicinal compound contents in Glycyrrhiza uralensis
Glycyrrhiza uralensis Fischer (Fabaceae), an important medicinal plant widely used in traditional Japanese and Chinese medicine, contains bioactive compounds, such as glycyrrhizin and flavonoids, which exhibit pharmacological activities, including antispasmodic and antitussive effects. Overharvesting has depleted wild populations, making the cultivation of G. uralensis necessary to stabilize its supply; however, the content of bioactive compounds tends to decrease in cultivated plants. In this study, we investigated the genetic inheritance (heritability) of medicinal compound contents in G. uralensis by analyzing clonal lines propagated from stolons. Broad-sense heritability was estimated for seven medicinal compounds using 26 clonal lines, revealing high heritability for glycyrrhizin and several flavonoids. In addition, correlation analyses between seed-derived and stolon-derived roots demonstrated strong genetic inheritance of these compounds. Furthermore, the effects of plant age and cultivation year on compound content were examined. Our results show high correlations between compound content and genotype across plant age (one- and two-year-old plants), suggesting the feasibility of early selection in breeding programs. While environmental variations influenced absolute compound levels, the relative rankings among genotypes remained stable. These results indicate the high heritability of compound contents and the strong effectiveness of selective breeding. We conclude that there is strong potential for selective breeding to enhance the medicinal quality of G. uralensis by targeting high-yielding genotypes with superior compound profiles and that this potential may also apply to the sustainable cultivation of other high-quality medicinal plant resources.
Economic deprivation and intimate partner violence in Germany
This article examines the association between economic deprivation and the likelihood of experiencing physical intimate partner violence (IPV) in Germany. Although international studies have shown a link between economic deprivation and IPV, analyses utilizing probability-based surveys to examine this association in Germany are scarce. Within the framework of an economic power resource approach and using the German Family Panel pairfam, a large probability-based panel, this study aims to fill this gap. Results of linear probability models show that being unemployed and being unsatisfied with the household finances, as indicators of economic deprivation, significantly increase the risk of physical IPV. A range of sensitivity checks corroborate these findings.
Predictive ability of plasma concentration of triglyceride/high density lipoprotein-cholesterol ratio for cardiometabolic variables in a sub-Sahara black African adolescent population–Nigerians
Introduction This study aimed to determine whether triglyceride/high-density lipoprotein cholesterol (TG/HDL-c) ratio, which has been shown to be an innovative proxy marker of atherogenic indicator in the human plasma, and an indicator of the metabolic syndrome (MetS) and insulin resistance (IR), can predict systolic hypertension (SHT), diastolic hypertension (DHT), diabetic fasting plasma glucose (dFPG), hypertriglyceridemia (HTG), hypercholesterolemia (HCHOL), low high-density lipoprotein-cholesterol (HDL-c) and high low-density cholesterol (LDL-c) in the Nigerian adolescent population living in metropolitan Lagos, Southwest Nigeria. Methods A dietary and nutritional survey (DNS) was conducted from October 2019 to March 2020. A total of 650 adolescent participants were recruited using a four-stage stratified sampling method but statistical analysis was restricted to the 613 who had complete anthropometric and clinical data. The sensitivity, specificity, and distance to the corner on the receiver operating characteristic (ROC) curve in each TG/HDL level were calculated. The shortest distance in the ROC curves was used to determine the optimal cutoff of the TG/HDL-c ratio for detecting MetS, Systolic and diastolic hypertension and diabetes. Results In all the subjects, the median TG/HDL-c ratio was significantly higher (P-value <000001) only among those with, than those without MetS (8.2 vs 3.0), those with and without hypertriglyceridemia (4.2 vs 1.3), hypercholesterolemia (5.3 vs 2.8), low high-density lipoprotein-cholesterol (7.2 vs 2.5) and high low-density lipoprotein-cholesterol (3.3 vs 1.8, P-value = 0.0001). The prevalence of systolic hypertension, diabetic FPG, total cholesterol and LDL-c was higher with higher TG/HDL-c ratio while that of HDL-c was lower with higher TG/HDL-c in all subjects. TG/HDL-c ratio was strong in predicting dyslipidemia, especially hypertriglyceridemia and hypercholesterolemia in early and mid-adolescents and cardiometabolic risk factors of two or more in adolescents. An inverse relationship was observed between the stages of adolescence and cutoffs for MetS. Conclusions TG/HDL-c ratio effectively predicted MetS, hypertriglyceridemia and hypercholesterolemia among early and mid-adolescent Nigerians. As a tool, the TG/HDL-c ratio should be considered for the initial prediction of MetS and some of its dyslipidimic components. Further studies are needed to confirm findings in this study.
Advancing medical question answering with a knowledge embedding transformer
Efficient medical question answering is essential for better patient care. Despite progress since Eliza (1966), even advanced LLMs (e.g., GPT-4) struggle with medical data. This study presents a system combining knowledge embedding and transformers. It includes a knowledge understanding layer and an answer generation layer. Tested on the MedQA dataset, it achieved 82.92% accuracy, outperforming GPT-4’s 71.07%. The results demonstrate the system’s ability to deliver accurate and ethical answers. This integrated method improves response speed and quality. Future work will enhance precision, support patient interaction, and integrate multimodal data for improved healthcare query processing.
A systematic approach to study the effects of acquisition parameters and biological factors on computerized mammography analysis using ex vivo human tissue: A protocol description
Background: Mammography is the most common imaging modality for the detection of breast cancer. Artificial intelligence algorithms for mammography analysis have shown promising performance for breast cancer risk assessment and lesion detection and classification; however, these models often fail the test of external validation. The evidence points to variations in image acquisition—known as the batch effect—as a main contributing factor to the lack of the models generalization and robustness. However, studies on the effects of acquisition in the mammogram have been limited due to lack of appropriate datasets. This prospective, exploratory, non-randomized study aims to study how biological and non-biological sources of heterogeneity affect the mammogram and, in turn, the computerized models for mammography analysis. Methodology: This study will collect breast samples from 200 participants that will undergo breast resection as per clinical indications. Each sample will undergo the mammography imaging procedure several times to obtain mammograms with different combinations of imaging parameters. The resulting dataset will be used for the statistical analysis of the impact of imaging parameters in mammographic texture features and the computerized analysis of mammograms. Furthermore, biological information will be collected from the resected breast samples to study their relation to mammographic texture features. Discussion: This study will add to the understanding of the effect of different sources of heterogeneity on mammography, ultimately aiding in the future development of robust computerized analysis models.
DMSO induces major morphological and physiological alterations in zebrafish embryos
Dimethyl sulfoxide (DMSO) is a polar aprotic solvent that dissolves both polar and nonpolar compounds and is miscible in a wide range of organic solvents as well as water. These characteristics render DMSO one of the most widely used solvents in pharmaceutical industry, as well in basic biomedical research, such as in developmental biology studies. The analysis of the effects of DMSO during the development of zebrafish larvae is particularly important since zebrafish is one of the most studied vertebrate models in developmental biology and in toxicology. It has been reported that DMSO at concentrations up to 1% are safe to be used in zebrafish embryo developmental toxicity assays, but fundamental questions such as whether and how different concentrations of DMSO affect the morphology and physiology of zebrafish have not been investigated. Therefore, our study focused on the analysis of DMSO treatment during zebrafish development using high resolution optical microscopy and real-time video-microscopy of the whole embryo, as well as focusing on some organs and tissues. Our results show that concentrations above 5% of DMSO are lethal to embryos, whereas concentrations between 1–4% induce different morphological and physiological alterations in embryos. The alterations observed include up-curved tail, heart beating frequency, heart edema, somite size, myofibril alignment, melanocyte size, notochord and swim bladder morphology. These results show for the first time a detailed analysis of the major effects of the widely used solvent DMSO during zebrafish development and call for attention in the use of DMSO in basic and applied research.
Analysis of hemorrhagic transformation and intracerebral hemorrhage under combination therapy with alteplase and antiplatelets or anticoagulants, using the Japanese Adverse Drug Event Report database
Recombinant tissue-type plasminogen activators (rtPA) effectively dissolve blood clots and improve symptoms in patients with acute ischemic stroke and myocardial infraction. Although rtPA are used in patients taking antiplatelets or anticoagulants to improve clinical outcomes, combination therapy may increase the risk of hemorrhagic transformation (HT) and intracerebral hemorrhage (ICH). However, few studies have investigated the risk of HT and ICH associated with these combination therapies. This study aimed to investigate the adverse-event and drug-drug interaction signals for HT and ICH under combination therapy with alteplase and various antiplatelets or anticoagulants, using the Japanese Adverse Drug Event Report database. Adverse-event signals were evaluated using the reporting odds ratio and information components, and drug-drug interaction signals were studied using the Ω shrinkage measure, additive, multiplicative, and Chi-square statistics models. We also investigated predictors of HT and ICH, time-to-onset, and outcomes in patients receiving alteplase. HT and/or ICH signals were detected in patients receiving alteplase in combination with aspirin, P2Y12 inhibitors, cilostazol, ozagrel sodium, direct oral anticoagulants, warfarin potassium, heparin group, or argatroban. Hypertension and diabetes mellitus were significant risk factors for alteplase-induced HT. Most HT and ICH events occurred within 1 day after alteplase administration, and more than 60% of affected patients were not in recovery. In conclusion, continued monitoring is required in patients receiving alteplase in combination with any of the eight types of antiplatelets or the aforementioned anticoagulants. Additionally, the occurrence of HT or ICH within 1 day post-alteplase administration should be considered in patients with hypertension or diabetes mellitus. The findings from this study may help in understanding the risk of HT and ICH induced by rtPA in patients taking antiplatelet or anticoagulant medications, as well as in promoting the appropriate use of rtPA. Further prospective observational studies and randomized controlled trials are needed to assess these finding.
Time series analysis of dengue incidence and its association with meteorological risk factors in Bangladesh
Dengue is a mosquito-borne viral disease affecting tropical and subtropical regions. In Bangladesh, dengue fever remains a rising public health threat driven by meteorological factors. This study aimed to assess the temporal trends and how meteorological factors influence dengue incidence in Bangladesh from 2008 to 2024. Monthly reported dengue cases were analyzed using time series forecasting techniques and multivariate Poisson regression models. Seasonal Autoregressive Integrated Moving Average (SARIMA) and Extreme Gradient Boosting (XGBoost) models were used for forecasting. Correlation analysis and Poisson regression assessed meteorological effects with one- and two-month lags. The result indicates that the highest number of dengue cases was found in September 2023 (79,598 cases). Autocorrelation revealed a strong positive correlation at 1-month and 2-month lags. Forecasts from 2024–2027 predict that dengue cases will fluctuate between 10,000 and 20,000 annually from the predictive models. Spearman’s rank correlation indicated significant positive associations between dengue cases and precipitation, temperature, wind speed, and humidity. Multivariable Poisson regression revealed that temperature (°C) (IRR = 1.02), Humidity (%) (IRR = 1.25), and Wind speed (m/s) (IRR = 1.10) significantly increased dengue incidence. Between multivariate SARIMA, XGBoost, and Poisson regression, the best-performing model was ARIMA (RMSE: 5058.066). In conclusion, the study highlights the substantial influence of climatic factors on dengue dynamics in Bangladesh, emphasizing the need to integrate meteorological data into early warning systems and develop adaptive, climate-informed control and surveillance strategies.
Estimating the prevalence alcohol use disorder and relapse risks in Kermanshah Province of Iran: Integrating direct, indirect methods, and tree-based analysis
Background Alcohol Use Disorder (AUD) is a major health issue in various societies, particularly in Iran, with detrimental consequences. In this study, we examined the prevalence of AUD using direct and indirect methods (Network Scale-Up model (NUS) and Crosswise model (CM)), as well as the factors associated with relapse, utilizing tree analysis. Methods In this cross-sectional study conducted among individuals aged 15–69 in Kermanshah Province, western Iran, 6,127 participants were selected using stratified sampling. Data collection was performed electronically and recorded in a digital system by trained interviewers. The indirect assessment utilized both NUS and CM methods and Factors affecting the recurrence of alcohol use were investigated using the tree regression method. Results The prevalence of AUD in western Iran was estimated at 3.20% using direct methods, 20.54% using the CM method, and 7.21% using the NUS method. A total of 34 (0.7%) individuals reported relapse in AUD. Tree analysis results indicated that the frequency of relapse (chi square = 4994.0, P < 0.001) and a history of physical illness in the family (chi square = 6.0, P = 0.031) were influential factors in alcohol relapse. Conclusion The findings of this study provide insights into the actual levels of AUD and factors associated with relapse, enabling healthcare providers to make better decisions for preventive planning to reduce AUD and improve treatment outcomes.
Community-based health insurance dropout and its determinants among women in Sidama National Regional State, Southern Ethiopia, 2024: A multilevel analysis
Introduction Ensuring accessible and affordable healthcare continues to be a key priority in low- and middle-income countries, including Ethiopia. To enhance healthcare coverage and provide financial protection, especially for vulnerable populations such as women, community-based health insurance (CBHI) schemes have been introduced. Despite these efforts, dropout rates from the program remain a challenge, threatening its long-term sustainability. This study investigated determinants of CBHI dropout among women in Sidama Regional State, Ethiopia. Methods A community-based cross-sectional study was conducted between December 15, 2023, and January 12, 2024, involving 835 women aged 18 years and above in the central zone of Sidama. Participants were selected via a multistage sampling technique. Data were collected through structured, pre-tested face-to-face interviews encompassing demographic, household, and scheme-related factors. Multilevel logistic regression analysis was performed using Stata version 17 to identify factors associated with CBHI dropout. Adjusted Odds Ratios (AOR) with 95% Confidence Intervals (CI) were reported, with statistical significance set at p < 0.05. Findings Among the 845 women sampled, 835 participated in the interviews with a response rate of 98.8%. Of these, 77 women (9%) dropped from the CBHI scheme (AOR = 9; 95% CI: 7.43% −11.38%; p < 0.001). Lower dropout likelihood was significantly associated with increased age (AOR = 0.93; 95% CI: 0.89–0.97; p < 0.001) and larger family size (AOR = 0.28; 95% CI: 0.17–0.50; p < 0.001). Conversely, reduced transparency in decision-making (AOR = 2.05; 95% CI: 1.39–3.00; p < 0.001) and insufficient advocacy (AOR = 3.01; 95% CI: 2.29–7.00; p = 0.011) were positively associated with dropout. At the community level, residing in low-poverty areas (AOR = 0.29; 95% CI: 0.09–0.98; p = 0.046) and high-autonomy communities (AOR = 0.14; 95% CI: 0.04–0.50; p = 0.002) were associated with reduced dropout rates. Conclusion This study identified factors linked with women’s dropout from the CBHI program that threaten sustainability. Lower dropout rates were linked with older age and larger family size, while poor transparency in decision-making and weak advocacy were associated with increased dropout rates. Communities residing in low-poverty and high-autonomy areas were also associated with decreased dropouts.
Cataract surgery and the risk of developing recurrence or progression of diabetic macular edema
Purpose To determine whether uneventful cataract surgery in patients with diabetic macular edema (DME) affects the course of the disease, and its relationship with postoperative clinical outcomes in real-world settings. Materials and Methods This retrospective cohort study included patients of center-involving DME and a prior history of periocular injection in the operative eye before cataract surgery with a follow-up of at least 6 months. Patients were assigned to active and inactive DME group according to preoperative status. Patients’ clinical outcome measurements before and after cataract surgery were compared between the groups. Cox-proportional hazards model was performed to identify risk factors of DME recurrence or progression after cataract surgery. Results The study included 153 eyes in 153 patients. No significant differences were observed in the trend of the groups’ clinical outcomes, including best-corrected visual acuity, central macular thickness and central choroidal thickness (P = .763,.872, and.127, respectively). Patients with higher HbA1c were more likely to develop recurrence or progression of DME after cataract surgery (hazard ratio = 1.407, P = .039). Conclusion The clinical outcomes following cataract surgery in patients with inactive or actively treated DME did not show significant differences at any postoperative period. Recurrence or progression of DME after cataract surgery was found to be associated with high HbA1c. Clinicians do not have to delay the cataract surgery in patients with DME who have good glycemic control and are undergoing treatment as needed.
The consistency of Federalist Society-affiliated U.S. supreme court justices
The U.S. Supreme Court has recently undergone a dramatic turn to the right, fundamentally reshaping law and politics in America. In this article, we examine one reason for this shift: the increasingly prominent role of the Federalist Society in the conservative legal movement. An analysis of almost 25,000 votes of Supreme Court justices from 1986–2022 shows that justices affiliated with the Federalist Society are about 10 percentage points more likely to cast a conservative vote than their non-affiliated counterparts, and the voting behavior of Federalist Society-affiliates is more ideologically consistent than non-affiliated justices. Because justices in the contemporary era serve on the Court for an average of about a quarter century, these findings indicate that we are likely to see the Court’s conservative justices – who are all Federalist Society-affiliates – continue to advance the conservative legal movement’s agenda for decades to come.
Net ownership, utilization and malaria burden in the context of Piperonyl butoxide-LLINs intervention in western Kenya
Background Pyrethroid-treated nets have reduced malaria in endemic areas, but insecticide resistance has hindered progress, prompting WHO to recommend piperonyl butoxide (PBO) based long-lasting insecticidal nets (LLINs). Kenya adopted PBO nets, but their usage is not well documented. This study aims to assess the uptake and effect of PBO nets versus pyrethroid-only LLINs (pyrethroid-LLINs) on malaria transmission in Western Kenya. Methods A cross-sectional study was conducted in Muhoroni Sub-County, Kisumu County, one year after net distribution between November and December 2023. Twelve villages were randomly selected, comprising 380 households and divided into two intervention arms of six villages. Group 1, with 181 households, received pyrethroid-LLIN, while Group 2, with 199 households, received PBO-LLINs. Data on net ownership and usage was collected using a standardized semi-structured questionnaire. Finger prick blood smears were collected on slides for microscopic examination, while dry blood spots (DBS) on filter paper were collected for real-time PCR (RT-PCR) diagnosis of Plasmodium infection in both intervention groups. Logistic regression was used to identify factors influencing net ownership and malaria prevalence, while a generalized linear model assessed factors affecting net usage. The χ² test was used to evaluate differences in demographic characteristics between the intervention arms. Results Overall, higher net ownership and usage was recorded in PBO-LLINs group compared to the pyrethroid-LLIN group after one year of net distribution. Among households, 89% in the pyrethroid-LLIN group and 96% in the PBO-LLIN group owned at least one net. Net usage was 80.2% in the pyrethroid-LLIN group and 87.6% in the PBO-LLIN group. Net attrition rate was 17.9% in pyrethroid-LLIN and 7.6% for PBO-LLIN group. Households with nets were 1.3 times more likely to use them [aOR=1.338 (95% CI = 1.224–1.462), p < 0.001). Bed ownership was 50.8% in the pyrethroid-LLIN group and 55.3% in the PBO-LLIN group. Not owning a bed decreased the likelihood of net usage by 13.3% [aOR=0.867 (95% CI = 0.816–0.920), p < 0.001]. Between the two groups, 75.7% of households in the pyrethroid-LLIN group and 66.8% in the PBO-LLIN group reported bedbug infestations in their homes. Bedbug infestation significantly affected net ownership (p = 0.018). Malaria parasite prevalence was 34.7% by qPCR in the pyrethroid-LLIN group and 29.0% in the PBO-LLIN group, with a prevalence ratio of 0.84 (95% CI: 0.65–1.03). Conclusion The study observed higher bednet ownership, usage, and lower malaria prevalence in the PBO-LLIN clusters compared to the pyrethroid-LLIN clusters. However, bedbug infestations and insufficient sleeping beds hindered net ownership and usage, limiting their overall effectiveness. These findings highlight the need for National Malaria Control Programs (NMCPs) to enhance community education on proper net use and maintenance through targeted initiatives, such as household visits and local workshops. Furthermore, incorporating bedbug control strategies and regular surveillance will improve compliance and net usage. Addressing these challenges will maximize the impact of PBO-LLINs and other next-generation nets, strengthening malaria control and elimination efforts in both urban and rural settings.
Association between serum lipase levels and chronic kidney disease stages
Objective To explore the relationship between serum lipase levels and chronic kidney disease (CKD) progression, evaluating its usefulness in assessing efficacy, severity, and predicting outcomes in CKD. Methods This retrospective study analyzed 251 CKD patients treated at our hospital from January 2018 to December 2023, categorizing them into four groups based on 2022 Chinese and 2024 KDIGO guidelines. Clinical and biochemical data, including serum lipase, Scr, and BUN were collected. Additionally, a supplementary cohort of 50 CKD patients treated between January 2024 and March 2025 was included to support the findings. Results Serum lipase levels increased with advancing CKD stages [G1-2: 40.50 (30.75,52.00), G3:47.00 (37.25,61.00), G4:100.00 (77.00,126.00), G5:155.50 (126.75,243.75), (P < 0.05), showing a positive correlation with Scr (r = 0.714, P < 0.001) and BUN ((r = 0.678, P < 0.001). Univariate logistic regression analysis indicated that age, Scr, BUN, and serum lipase were positively associated with CKD stages, whereas HDL-C exhibited negative correlations. Multivariate logistic regression analysis identified several associated factors of CKD stages, including Scr (OR=1.01; 95% CI 1.01–1.02; P < 0.001), BUN (OR=1.17; 95% CI 1.07–1.29; P < 0.001), age (OR=1.03; 95% CI 1.01–1.05; P = 0.019), and serum lipase (OR=1.02, 95% CI 1.01–1.03, P < 0.001). Serum lipase’s AUC for distinguishing CKD stages G1-2 vs. G3, G3 vs. G4, and G4 vs. G5 were 0.64 (0.55–0.73), 0.89 (0.83–0.94), and 0.84 (0.75–0.93), respectively, with validation cohort AUCs of 0.65 (0.45–0.85), 0.82 (0.62–1.00), and 0.86 (0.65–1.00). Conclusions Serum lipase emerges as a novel biomarker for CKD stages, exhibiting stage-dependent increases and independent prognostic significance. Regular testing could improve risk assessment and complement current markers like eGFR and proteinuria, enhancing CKD management.