To estimate total body fat percentage (TBFP) percentiles and their association with obesity and cardiometabolic risk biomarkers in the United States adult population. Cross-sectional data for adults (20-59 years) from the 2011-2018 National Health and Nutrition Examination Survey (NHANES) were analyzed (N = 14,347). TBFP was assessed using dual-energy X-ray absorptiometry. TBFP percentiles were calculated using age-adjusted, weighted quantile regression. Receiver operating characteristic (ROC) analyses assessed the ability of TBFP to predict obesity (body mass index [BMI] ≥ 30 kg/m2), elevated HbA1c (≥ 5.7%), and alanine aminotransferase (ALT) thresholds (≥ 20 and ≥ 40 U/L); and the ability of BMI to predict elevated TBFP. TBFP percentiles were similar across groups, but non-Hispanic Black men had significantly lower odds of TBFP ≥ 90th percentile compared with non-Hispanic White men. TBFP demonstrated accuracy in predicting BMI-defined obesity (AUC 0.83-0.91), and BMI demonstrated accuracy in predicting elevated TBFP (AUC 0.80-0.90). TBFP had limited ability to predict elevated HbA1c (AUC 0.52-0.65) and ALT (AUC 0.51-0.63). TBFP percentiles are associated with BMI-defined obesity but are insufficient to predict cardiometabolic risk independently. These findings support the continued use of BMI as a screening tool and suggest that TBFP may complement but not replace existing measures.
Having knowledge of out-of-pocket cost and access to services constitutes an advanced level of health literacy within the Medicare population. The cost and services offered within Medicare change annually, yet less than 30% of beneficiaries compare their coverage options (between traditional or fee-for-service Medicare and Medicare Advantage)-an important application of health care knowledge. Failure to compare can expose the financing of the Medicare program and the beneficiary to financial risk if a beneficiary has not elected a coverage option that best suits their individual needs. The factors driving beneficiaries to compare are poorly understood. Our objective was to examine the association between different levels of information reviewed (exposure) and comparing coverage (outcome). This pooled cross-sectional study included 28,924 Medicare beneficiaries using data from the 2019-2021 Medicare Current Beneficiary Survey. Multivariable probit regressions were performed using Stata version 18. Reviewing both cost and service information increased the probability of comparing coverage by 159% (44.4 percentage points). Exposure to service-only information increased the probability of comparing coverage by 97% (27.2 percentage points) and 68% (19.1 percentage points) for cost-only information, relative to those who reviewed neither cost nor service information. Forty-seven percent of beneficiaries did not review cost nor service information, followed by 39% who reviewed both, 8% cost-only, and 6% service-only. The probability of comparing coverage increased by 8.2% (2.3 percentage points) for beneficiaries who reviewed both cost and service information and those who had an education greater than high school. A targeted outreach and education campaign geared toward increasing the type of information reviewed could result in an increase in comparing Medicare coverage options. We examined factors associated with beneficiaries comparing their option to elect either traditional Medicare or Medicare Advantage. In this study, review of both out-of-pocket cost and access to services increased the probability of comparing coverage options. These findings suggest policymakers and the Centers for Medicare & Medicaid Services should focus on crafting targeted campaigns to increase the level of health literacy for Medicare beneficiaries.
Recent guidelines for spirometry interpretation recommend the use of z-scores rather than percent-predicted values to classify the severity of lung function impairment. The potential impact of this change remains unknown. To evaluate the proportion of individuals whose severity classification would change with a transition to z-scores, and to assess how changes in classification are associated with respiratory symptoms and outcomes. We evaluated two cohorts of individuals with spirometry: (1) individuals from NHANES III and (2) individuals with COPD from the Johns Hopkins Health System. Using the former and current ATS thresholds, all individuals were classified as normal, mild, moderate, or severe according to both their FEV1 percent-predicted and z-score. Individuals were classified as less severe, more severe, or unchanged with a shift from percent-predicted to z-score thresholds. We evaluated the association between a change in classification with dyspnea, cough, wheeze, phlegm, and mortality in the NHANES cohort, and with COPD exacerbations, all-cause hospitalizations, and cachexia in the COPD cohort using multivariable logistic or Cox regression analyses. A total of 14,863 individuals were included in the NHANES cohort and 14,238 in the COPD cohort. In the NHANES and COPD cohorts, respectively, the mean age was 44 and 64 years, and the mean FEV1 was 3.01 L and 1.75 L. Among the NHANES cohort, 1,497 (10%) individuals were classified as a lesser severity with z-scores, and 6,970 (49%) were classified as a lesser severity among the COPD cohort. No individuals were reclassified to a higher severity under z-scores. Compared to individuals with no change in their severity classification, those reclassified to lesser severity with z-scores had a corresponding lower risk of dyspnea (OR 0.76; 95% CI 0.62-0.92), mortality (hazard ratio [HR] 0.82, 95% CI 0.71-0.93), COPD exacerbation (OR 0.45, 95% CI 0.35-0.58), and all other outcomes except cough. A shift from percent-predicted values to z-scores for spirometry interpretation results in reclassification of severity for a substantial proportion of individuals and particularly among those with COPD. Individuals reclassified to lesser severity have a corresponding lower risk of clinically relevant outcomes, supporting the use of z-score threshold for spirometry interpretation.
This exploratory study determined which of 14 selected predictors of autism spectrum disorder (ASD) found in individual-level research are predictive of ASD prevalence rates in the 50 U.S. states without and with statistical control for socioeconomic status (SES). Analyses used 2017 state ASD rates and SES, race, Big Five personality, IQ, urban population percent, air pollution, health care providers per population, physician shortage, per pupil spending, PN-3 policy and strategy, percent without health insurance, Medicaid-CHIP enrollment, maternal age, prepregnant obesity, and low birth weight variables based on various samples largely from 2017. ASD rates correlated significantly with each of the 15 potential predictors except for percent uninsured, Medicaid-CHIP enrollment, and air pollution (p = .051). However, when each of the 14 potential predictors entered alone on the second step of a regression equation with SES controlled, only race, personality, urbanization, air pollution, PN-3 policy and strategy, and maternal age were significant predictors. Additionally, an equation with these six predictors entered simultaneously on a second step showed that only SES and air pollution were significant. In another equation with only SES and air pollution entered as predictors, they jointly accounted for 55.7% of the variance in state ASD prevalence rates. Both higher SES and greater air pollution were associated with higher ASD prevalence. There was no evidence of multicollinearity or spatial autocorrelation in the 15 regression equations. These results suggest that considering SES and air pollution could prove beneficial in aggregate-level or individual-level analysis of factors associated with an autism diagnosis.
Adolescents with severe obesity and metabolic dysfunction-associated steatotic liver disease (MASLD) lack prospective comparative evidence to select between bariatric surgery and intensive lifestyle intervention. To compare 52-week histological and cardiometabolic outcomes of vertical sleeve gastrectomy (VSG) versus comprehensive lifestyle intervention (CLI). Single-centre, prospective, parallel-arm study of adolescents aged 12-19 with severe obesity and biopsy-confirmed MASLD with NAFLD Activity Score (NAS) ≥ 3. The primary endpoint was NAS ≥ 2-point decrease without fibrosis worsening; secondary endpoints included MASH resolution, fibrosis regression, MRI proton density fat fraction (MRI-PDFF) and elastography (MRE). Overlap-weighted adjusted analysis addressed baseline imbalance. Conservative unadjusted intention-to-treat analogue analyses treated missing Week 52 histology as nonresponse and missing continuous outcomes as no change. Forty-two adolescents enrolled (VSG = 17; CLI = 25) and 27 (64%) completed paired Week 52 histology. In the adjusted analysis, VSG was associated with a higher probability of NAS improvement (risk difference [RD] 0.68, 95% CI 0.45-0.91), fibrosis improvement (RD 0.36, 95% CI 0.12-0.59) and complete MASLD resolution (RD 0.49, 95% CI 0.26-0.72) when compared to CLI. VSG produced greater reductions in percent weight (-19.6%, 95% CI -30.0 to -9.1), percentage of the 95th percentile BMI (-27.6%, 95% CI -42.6 to -12.7), ALT (-54.0 U/L, 95% CI -80.8 to -27.1) and MRI-PDFF (-8.0%, 95% CI -13.0 to -2.9). Findings were directionally consistent in conservative unadjusted intention-to-treat and paired-biopsy completer analyses. In this prospective cohort of adolescents with severe obesity and biopsy-confirmed MASLD, VSG achieved greater 52-week histological improvement, including steatosis and fibrosis, than CLI. ClinicalTrials.gov identifier: (NCT02412540).
Intraoperative electron radiotherapy (IOERT) can be applied during breast conserving surgery to treat invasive breast cancer. Tumor-infiltrating lymphocytes (TILs) are fundamental elements of the specific immunological response against tumor cells and have prognostic importance in many types of cancer. The aim of the study was to analyze the local recurrence rate, adverse effects, surrogate molecular subtype, and stromal percentage of TILs in patients with breast cancer treated with exclusive IOERT. Eighty-one patients with early-stage breast carcinoma were included in a prospective study and were treated performing a conservative surgery, followed by IOERT with a dose of 20 Gy as accelerated partial breast irradiation (APBI). TILs were evaluated in hematoxylin-eosin sections of surgical specimens before IOERT. The median follow-up of the patients was 58 months (range 15-128). Fifty-eight patients (71.6%) were classified as Luminal A-like, 21 patients (25.9%) Luminal B-like and 2 patients (2.5%) were classified as HER2 positive-like. The local recurrence rate was 2.5%. Two patients presented ipsilateral local recurrence, and one patient presented distant recurrence. Eight patients (9.9%) suffered chronic toxicity with grade 1 localized fibrosis, fat necrosis, and pain. Eighty-one percent of stromal TILs were low and 14.9% were intermediate. In 3 patients (4.1%) the stromal percentage of TILs could not be assessed. In this prospective cohort of carefully selected patients with early breast cancer, exclusive IOERT delivered as accelerated partial breast irradiation achieved favourable local control with minimal chronic toxicity. Predominantly low stromal TIL levels in luminal-like tumours may be associated with recurrence risk. Larger prospective studies are needed for validation.
Increasing access to kidney transplantation for patients with end-stage renal disease is a high priority in the United States. Recent policy changes to promote this include establishment of performance metrics examining the pretransplant performance of kidney transplant programs, but little is known about transplant program practices associated with these performance metrics. Our goal is to characterize waitlist attributes associated with the newly established pretransplant performance metrics at adult kidney transplant programs. We conducted a retrospective cohort analysis using completed case national data from the Scientific Registry of Transplant Recipients (SRTR). Exposures included deceased donor kidney waitlist attributes such as waitlist prevalence, waitlist incidence, percentage of incidence patients who are made status active, and transplant priority scores at key points including activation. Outcomes included pretransplant mortality rate ratio (PMRR) and organ acceptance rate ratio (OARR), as defined by the Organ Procurement Transplant Network (OPTN) Membership and Professional Standards Committee, for each transplant program-year. Our study included 1268 transplant program-years from 2015 to 2020, representing 220 unique adult kidney transplant programs. Higher offer acceptance was associated with fewer patients on the waitlist (1.4% increase per every 100-patient decrease) and a higher percentage of patients receiving an offer within 90 days of activation (24.0% increase per 10% increase in the percent of patients receiving offers). Lower pretransplant mortality was associated with fewer patients on the waitlist (1.4% decrease per 100-patient decrease). A larger waitlist was associated with both higher pretransplant mortality and lower offer acceptance. Transplant programs behaviors underlying waitlist attributes associated with better or worse outcomes warrant additional investigation.
Motivational interviewing (MI) is a patient-centred, goal-oriented psychotherapy for alcohol use disorder (AUD) and numerous other conditions. While some language patterns have been linked to MI response, less is known about how broader linguistic features, sentiment, and engagement relate to post-intervention drinking. This study used natural language processing to examine these associations and clarify mechanisms through which MI for AUD exerts its effects. Adults with AUD (N = 68) completed a single MI session with structured feedback and discussion of potential drinking changes. Speech transcripts were analysed for change-, emotion-, motivation-, substance-, and health-related words. Sentiment analysis assessed emotional polarity, and engagement was measured by total words spoken. Linear regression models tested associations between linguistic features and drinking outcomes, including drinks/week, percent heavy drinking days (%HDD), and percent drinking days (%DD). Participants showed significant reductions in drinks per week and %DD. Consistent with recent reviews of MI predictors, linguistic analyses found that greater use of change talk and health-related language was associated with more drinks per week at follow-up, whereas greater emotional talk and positive sentiment predicted fewer drinks per week. Health- and substance-related language predicted higher %HDD, while social motivation-related language predicted lower %DD. Term-frequency and multivariate analyses supported these patterns. Via natural language processing of MI speech, linguistic features such as motivational content and sentiment were linked to drinking outcomes. Findings demonstrate the potential of this approach as a scalable, data-driven complement to traditional coding systems, with applications for real-time feedback, clinician training, and personalized interventions.
The purpose of this study was to assess outcomes after treatment of scaphoid nonunion with open reduction internal fixation and nonvascularized autograft (NVA). This was a retrospective case series assessing all patients with scaphoid nonunions treated with open reduction internal fixation and NVA at a multispecialty orthopedic hospital from 2014 to 2024. Inclusion criteria were 12 weeks or greater from date of injury to date of surgery. Exclusion criteria were absence of postoperative CT scan or presence of additional local procedures. Radiographic healing was defined as 50% bridging bone on CT scan. Ninety-nine patients were included in this study: 45 patients were treated with cancellous only autograft (COA), 52 were treated with corticocancellous autograft (CCA), and 2 were treated with osteochondral autograft. Ninety-five percent of patients healed. Median time to healing was 81 days. On first postoperative CT, obtained at a median of 77 days after surgery, 75% of patients were healed. Eighty-nine percent of patients had bridging bone present on first CT; 99% of these patients went on to heal. Thirteen patients in this study had a prior attempt at surgical fixation at another institution; all healed after revision surgery. There were no significant differences in the odds of healing at any time point or the time to healing for patients treated with CCA versus COA. Surgical treatment of scaphoid nonunion with NVA had a union rate of 95%. There were no significant differences in outcomes between patients treated with CCA and COA. Of patients who exhibited bridging bone on CT obtained at a median of 76 days after surgery, 99% went on to union. These findings support use of NVA for scaphoid nonunion and discourage the use of multiple postoperative CT scans to confirm healing. Therapeutic IV.
Sacral neuromodulation (SNM) is an established therapy for refractory bowel and lower urinary tract dysfunction. While its efficacy and patient satisfaction are well documented, little is known about the physical burden of the implant itself. This study aimed to evaluate patient perspectives on the implantable pulse generator (IPG) placed in the gluteal region. We reviewed 100 consecutive patients who underwent SNM within the past 2 years at a tertiary care center. Data were collected during follow-up visits or phone interviews using a five-question survey based on common patient concerns. Responses were analyzed descriptively, with statistical testing performed using SPSS version 29. Eighty-two patients received SNM for overactive bladder, 16 for urinary retention, and two for fecal incontinence. Sixty-two percent reported awareness of the IPG, 18% reported sleep or movement limitations, and 36% reported activity-related discomfort. Eleven percent turned off the device for non-MRI reasons. Overweight or obese patients (BMI >25) were less likely to report disturbances compared with normal-weight patients. Male patients were more likely than female patients to deactivate their device (P = 0.014), while older patients were less likely to turn it off. Most patients tolerated SNM well, though lower BMI was associated with greater discomfort, consistent with prior reports of higher revision rates in leaner individuals. Sex- and age-related differences suggest variations in device use behaviors, possibly due to lifestyle, activity level, or technological engagement. SNM is generally well tolerated, but leaner, younger, and male patients may experience greater device-related burden, highlighting the need for tailored counseling and device optimization.
Youth-onset type 2 diabetes and obesity are rising public health burdens. While newer type 2 diabetes medications lower HbA1c, their impact on paediatric weight loss is inconsistent. In contrast, bariatric surgery improves glycemia and weight in youth and adults, though glycemia post-vertical sleeve gastrectomy (VSG), now the predominant bariatric surgery in youth, remains unstudied in youth-onset type 2 diabetes. We aimed to assess immediate post-VSG glycemic patterns using continuous glucose monitoring (CGM) in adolescents with type 2 diabetes. In the Surgical or Medical Treatment for Paediatric Type 2 Diabetes (ST2OMP) study, 73 adolescents with type 2 diabetes underwent 14 days of CGM monitoring: 33 participants beginning in the 1-2 days post-VSG (mean age 17.6 years, 67% female, HbA1c 7.2%, BMI 50.0 kg/m2) and 40 participants receiving advanced medical therapy (AMT) (mean age 16.9 years, 53% female, HbA1c 7.8%, BMI 42.2 kg/m2). CGM analyses included glucose management indicator (GMI), time in range, coefficient of variability, standard deviation, mean amplitude glycemic excursion, percent > 140, 180, and 200, percent < 70 and 60 mg/dL, 7 a.m., and midnight-6 a.m. Mean glucose was 84.3 ± 23.4 in the post-VSG group versus 149.8 ± 78.8 mg/dL in the AMT group (p < 0.001). Mean CGM GMI was normal (5.3%, 34 mmol/mol) post-VSG versus in the diabetes range (6.9%, 52 nmol/mol) with AMT (p < 0.001). VSG participants spent more time < 70 mg/dL, 55 mg/dL, and 45 mg/dL (all p < 0.01). After BMI adjustment, preoperative HbA1c predicted postoperative glucose metrics. Adolescents with type 2 diabetes experience early glycemic normalization post-VSG, even before major weight loss.
Myricetin is a small-molecular-weight U.S. Food and Drug Administration-recognized dietary supplement showing efficient anticancer effects. The recent development of myricetin derivative Linebacker-1 (LB1), which changes a hydroxyl group on the B ring to a chlorine atom, exhibits DNA-binding ability by interacting with the minor grooves of DNA and may also act as an antitumor drug. This study demonstrates the anticancer effect and radiosensitization of LB1 in a lung cancer model. In vitro studies were performed in human A549 (American Type Culture Collection [ATCC]) and HT29 (ATCC), and in murine Lewis lung carcinoma (LLC1) (ATCC) cancer cell lines. A syngeneic murine model of lung adenocarcinoma was generated subcutaneously in 1 flank of wild (+/+) C57/BL6 background mice using the LLC1 cell line. Image guided radiation therapy (IGRT) targeting the tumor was administered with a small animal radiation research platform. Our in vitro study observations demonstrate that LB1 induces an antineoplastic effect in human lung A549 (P < .001) and colon HT29 (P < .001) adenocarcinoma cell lines. In the murine lung cancer model, we further demonstrate that a single dose of 8 Gy IGRT substantially enhances treatment response by reducing tumor volume (P < .01) and increasing survival percent and duration (P < .001). In addition, adding LB1 with a checkpoint inhibitor (antibody to programmed death-1 [anti-PD1]) or with IGRT+ anti-PD1 further increases the survival percentage (P < .05, P < .05, respectively), with no significant change in mouse body weight or body score. LB1 demonstrates enhancement of the antitumor effect of radiation in a lung cancer model, whereas anti-PD1 treatment further enhances the effect. The results provide impetus for further studies, including in vivo studies in orthotopic lung cancer models, to provide robust preclinical data for potential future application of LB1 as a radiosensitizer in the clinic.
Background: While physiological dependence on kratom (indicating tolerance and withdrawal) has been differentiated from kratom use disorder (KUD) in the West, the emphasis in Malaysia remains on kratom dependence. This has implications for treatment approaches.Objectives: This study was initiated to assess the extent to which medical practitioners treat patients with kratom dependence, their fields of specialization, their knowledge of kratom, and the treatment protocols used.Methods: An online questionnaire was distributed to approximately 17,000 Malaysian Medical Association (MMA) members, yielding 148 responses (0.9% response rate).Results: Male respondents comprised 58% of the sample, and 62% of physicians worked in public hospitals. Fifty-nine percent had treated patients for kratom dependence, with the majority having a background in psychiatry. Those treating kratom dependence had higher odds of being in public service (OR: 3.3: 1.64-6.56; p < .018), and had shorter mean duration of service (15.6 years), relative to the group that had not treated kratom dependence (18.3 years). Nearly 68% percent of those treating kratom dependence believed kratom to have similar effects as opioids and therefore prescribed treatments for kratom withdrawal that were designed for opioid withdrawal.Conclusions: Our findings suggest that opioid agonists are commonly used for the treatment of kratom withdrawal. However, kratom's distinct pharmacology relative to classical opioids suggests that treatment approaches developed for opioid withdrawal may not fully address the clinical features of kratom withdrawal.
The present study aimed to estimate macrosomia rates in Greece and investigate their temporal trends during the period 1980-2023. This nationwide population-based study analyzed official birth registry data obtained from the Hellenic Statistical Authority. The dataset included 4,593,229 live births registered in Greece between 1980 and 2023. For each year, overall macrosomia rates (birth weight ≥4,000 g) and severe macrosomia rates (≥4,500 g) were calculated. Additional analyses were performed separately for grade 1 (4,000-4,499 g), grade 2 (4,500-4,999 g), and grade 3 (≥5,000 g) macrosomia, according to gestational age at delivery (37-39 vs. ≥40 weeks), and among singleton live births. Temporal trends were evaluated using Joinpoint regression analysis, and annual percent change (APC) and average annual percent change (AAPC) values with 95% confidence intervals (95% CI) were calculated. During 1980-2023, the overall macrosomia rate declined by 63%, from 7.66% in 1980 to a historic low of 2.85% in 2023 (AAPC = -2.3, 95% CI: -2.5 to -2.2). The decrease was moderate during 1980-1992 (APC = -1.5, 95% CI: -2.1 to -0.5) and became particularly pronounced between 1992 and 2001 (APC = -4.4, 95% CI: -7.8 to -3.6) and again during 2007-2010 (APC = -10.2, 95% CI: -12.2 to -6.5), following a period of stabilization between 2001 and 2007. After a modest increase during 2010-2020 (APC = 1.4, 95% CI: 0.8 to 2.9), rates declined again during 2020-2023 (APC = -6.9, 95% CI: -12.1 to -3.1). Severe macrosomia (≥ 4,500 g) decreased by 81%, from 10.17 to a record low of 1.95 per 1,000 live births between 1980 and 2023 (AAPC = -3.9, 95% CI: -4.2 to -3.6). Grade 1 macrosomia (4,000-4,499 g), grade 2 macrosomia (4,500-4,999 g), and grade 3 macrosomia (≥ 5,000 g) declined, with corresponding AAPC values of -2.2 (95% CI: -2.3 to -2.0), -3.4 (95% CI: -3.7 to -3.0), and -6.2 (95% CI: -6.8 to -5.7), respectively. Macrosomia rates decreased more markedly among births at 37-39 gestational weeks (AAPC = -2.8, 95% CI: -3.0 to -2.6) than among births at ≥ 40 weeks (AAPC = -1.0, 95% CI: -1.3 to -0.8). Similar declining trends were observed among singleton live births, with the overall macrosomia rate decreasing from 7.80% to 3.02% and severe macrosomia decreasing from 10.36 to 2.06 per 1,000 singleton live births. Since 1980, Greece has achieved substantial reductions in macrosomia rates, which reached historically low levels in 2023. The decline was more pronounced for the more severe categories of macrosomia. Continued surveillance and targeted interventions in high-risk populations may further improve fetal growth outcomes in the country.
Urinary tract cancers and diabetes mellitus often co-occur and may interact to worsen clinical outcomes, yet long-term mortality patterns in this population remain poorly understood. Using national death certificate data from 1999 to 2024, we identified adults aged ≥25 years with both urinary tract cancers (ICD-10: C64-C68) and diabetes mellitus (ICD-10: E10-E14). Age-adjusted mortality rates (AAMRs) were standardized to the 2000 U.S. population. Temporal trends were assessed via Joinpoint regression to estimate annual percent changes (APC) and average annual percent changes (AAPC). Analyses were stratified by age, sex, race, region, and urbanization level. Deaths increased from 1, 566 in 1999 to 4, 487 in 2024; the AAMR rose from 0.87 to 1.53 per 100, 000 (AAPC 2.30%; 95% CI: 1.32%-3.29%). Mortality surged during 2018-2021 (APC 9.93%) before leveling off. Men had higher rates and a steeper rise than women (AAPC 2.42% vs. 1.00%). The oldest age group (≥85 years) showed the largest increase (AAPC 3.61%). Geographically, the South outpaced other regions (AAPC 3.57%), and nonmetropolitan areas exceeded metropolitan ones in both mortality level and growth (AAPC 3.19% vs. 1.85%). Among racial groups, non-Hispanic White individuals experienced the greatest rise (AAPC 2.51%). Over two decades, mortality from coexisting urinary tract cancers and diabetes rose substantially, with marked demographic and geographic disparities. Integrated prevention and management strategies are urgently needed.
Staphylococcus aureus (S. aureus) persistently colonizes the nares of approximately 20-30% of healthy individuals, and the nasal carriage constitutes a risk of infection and transmission. This pathogen causes mild to severe infections, different strains show variable virulence, and methicillin-resistant S. aureus (MRSA) is a global concern. Due to the worldwide aging of the population, further research in older adults is necessary, such as the study of their microbiota. To determine the carriage of S. aureus in older adults in Valparaíso, Chile, and to characterize the phenotype and genotype of their isolates. In a transversal and descriptive study, S. aureus strains were isolated from nasal swabs of 223 older adults. Antimicrobial susceptibility was determined by agar diffusion technique. The virulence genes: Panton-Valentine leucocidine (pvl), methicillin-resistance (mecA), toxic shock syndrome toxin-1 (tst), and enterotoxin A (sea) were detected by polymerase chain reaction. Genotyping of two methicillin-sensitive S. aureus (MSSA) strains and one MRSA was performed using MiSeq-Illumina and bioinformatics analysis. We identified 41 S. aureus strains in 18.3% [95%CI: 13.5 - 24.1%] of individuals, and the percentage of S. aureus in men was greater than in women. MRSA was 1.3% [95%CI: 0.3-3.9%] without differences between sexes. The isolates showed high resistance to penicillin, followed by erythromycin, clindamycin, and gentamicin. Twenty-four percent of MSSA strains showed multidrug-resistance. Virulence genes sea (6+/41 strains), mecA (3+/41), pvl (2+/41), and tst (2+/41) were detected. Additionally, the genotypes: ST5-SCCmecI-1B), ST398, and ST45 were identified, showing different virulence. Nasal carriage of S. aureus was similar to studies of the general population and the same age group from Latin America and Europe; however, MRSA carriage was higher. Strains from older adults exhibited variable pathogenic potential and antimicrobial susceptibility, identifying the Chilean/Cordobes clone and MSSA strains corresponding to CC398 and CC45 previously described in healthy carriers.
Calcaneal lengthening osteotomy (CLO) is a common procedure in children presenting with painful flatfeet refractory to conservative treatment. Although most pediatric flatfeet are flexible, a small percentage can present with rigid deformity. The purpose of this investigation is to compare the efficacy of CLO as a corrective procedure across patients with painful, rigid, and flexible flatfeet through radiographic outcomes and patient-reported pain and mobility scores. Seventy-two children (114 feet) aged 8 to 18 years undergoing CLO for painful, rigid, or flexible flatfeet with a minimum 6 months follow-up were included. Rigid versus flexible groups were determined based on chart review, noting physical examination findings of rigid flatfoot, including a lack of arch reconstitution when non-weight-bearing or standing on toes. Patients were excluded if they had neuromuscular disorders or prior surgeries affecting mobility, prior flatfoot correction, vertical talus, or tarsal coalition. A retrospective chart review was performed of preoperative and postoperative PROMIS pain and mobility scores. Preoperative and postoperative AP/lateral talo-first metatarsal angle, talonavicular uncoverage percent, incongruency angle, calcaneal pitch, and medial cuneiform-5th metatarsal height were measured. The mean final PROMIS follow-up was 23 months (median: 19; range: 6 to 84). Preoperatively, there were no significant differences in PROMIS pain (P=0.52) or mobility (P=0.79) scores. PROMIS pain significantly declined 7.8 points (P<0.001) in flexible feet and decreased 9.3 points (P=0.045) in rigid feet. Postoperatively, findings were similar, with no significant differences in PROMIS pain (P=0.73) or mobility (P=0.73) scores between flexible and rigid flatfeet. All radiographic parameters improved after surgery (rigid AP talo-first metatarsal angle, P=0.047; rigid lateral talo-first metatarsal angle, P=0.01; rigid incongruency angle, P=0.004; rigid calcaneal pitch, P=0.01; all other measures, P<0.001). Similarly, there were no differences in the postoperative radiographic measurements between groups (P>0.05). We found significant improvements in radiographic parameters and patient-reported pain after CLO for children with either flexible or rigid flatfeet. Our preliminary findings suggest CLO demonstrates promising short-term outcomes in both groups. Level III-therapeutic studies; investigating the results of treatment.
Dementia is a major cause of morbidity and mortality among older adults, and urinary tract infections (UTIs) are frequent, clinically significant complications in this population. However, there is limited national evidence describing mortality trends where UTI is listed as the underlying cause of death among individuals with dementia in the United States. We conducted a population-based descriptive study using the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research Multiple Cause-of-Death database (1999-2020). Deaths were identified using International Classification of Diseases, 10th Revision codes for UTI (N39.0) as the underlying cause and unspecified dementia (F03) as a multiple cause. We computed crude and age-adjusted mortality rates (AAMR) per 100,000, standardized to the 2000 US population. Temporal trends were assessed using joinpoint regression to estimate annual percent change and 95% confidence intervals (CIs), stratified by sex, age, race/ethnicity, region, and urbanization. Between 1999 and 2020, 125,797 deaths were attributed to UTI with comorbid unspecified dementia. The national AAMR increased from 18.20 to 26.30 per 100,000, with a non-significant annual percent change (-0.44%, 95% confidence interval = -1.38 to 0.51), suggesting no consistent annual increase. Mortality increased similarly in both sexes, but the absolute burden was higher in women. The highest mortality occurred among adults aged ≥75 years. Non-Hispanic White individuals accounted for most deaths and showed a 51.1% increase in AAMR. The greatest state-level rates were observed in South Carolina, North Carolina, West Virginia, Oklahoma, and Tennessee, while the lowest were in Arizona, Nevada, and Hawaii. Nonmetropolitan areas consistently experienced higher mortality. Mortality due to UTI as the underlying cause of death among older adults with dementia remained stable in the United States from 1999 to 2020, with notable geographic and demographic disparities. Women, non-Hispanic Whites, older adults, and rural residents carried the highest burden. These findings highlight the urgent need for improved infection prevention, timely diagnosis of atypical UTI presentations, and equitable access to healthcare for dementia patients, particularly in high-risk and rural regions.
The development of sustainable and biodegradable substitutes has increased due to growing environmental concerns surrounding petroleum-based polymers. Herein, starch-nanocellulose bio-nanocomposite films were fabricated and thoroughly characterized in order to assess the impact of nanocellulose fiber loading on their physicochemical, structural, thermal, optical, and mechanical properties. Using a straightforward solution-casting technique, sulfuric acid hydrolysis was used to remove nanocellulose from a filter paper and incorporate it into a thermoplastic starch matrix plasticized with glycerol. Water uptake, moisture absorption, and solubility analyses, tensile testing, X-ray diffraction (XRD), thermogravimetric analysis (TGA), and UV-vis spectroscopy were used to make and evaluate composite films containing 0, 5, 10, and 20 weight percent nanocellulose. Results demonstrated that increasing the nanocellulose content substantially decreased water uptake and moisture absorption because of the reduced free volume and increased hydrogen bonding within the matrix. The use of nanocellulose enhanced film continuity and decreased cracking, as demonstrated by morphological observations. TGA showed increased thermal stability at larger nanocellulose loadings, while XRD examination showed a steady rise in crystallinity from 32% for clean starch to 60% for the 20-weight percent nanocellulose composite. Although elongation at break reduced as a result of higher stiffness, mechanical testing revealed significant increases in tensile strength and Young's modulus with increasing nanocellulose concentration. These results show that the starch-nanocellulose bio-nanocomposites have enhanced strength, thermal resistance, and barrier qualities, underscoring their great promise as environmentally benign materials for biodegradable packaging and associated uses.
Growing evidence suggests that bacterial infectious diseases contribute substantially to morbidity and mortality among individuals with malignant neoplasms. However, data regarding mortality related to the co-occurrence of malignant neoplasms and other bacterial diseases is limited. This study analyzes the national mortality trends for the co-occurrence of malignant neoplasms and other bacterial diseases in the United States from 1999 to 2023. A retrospective study was conducted using Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research mortality data for individuals aged 15+ to calculate age-adjusted mortality rates (AAMRs) per 100 000 and annual percent change (APC) using joinpoint regression, stratified by year, sex, age, race/ethnicity, urbanization, and geographic regions. From 1999 to 2023, 726 510 deaths were recorded involving malignant neoplasms co-occurring with bacterial diseases. The AAMR slightly declined from 8.14 in 1999 to 7.63 in 2012, followed by a rise to 10.02 in 2023 with an APC of 2.51 (95% confidence interval: 2.14-2.89, P < 0.05). Males had higher mortality rates than females, declining until 2012, then increasing, while female rates were stable before rising after 2013. West exhibited the greatest increase in AAMR. Non-Hispanic Black individuals had the highest absolute AAMRs throughout the study period. Nonmetropolitan areas showed greater increases in AAMRs compared to metropolitan areas. Older age groups, especially those 65 years and above, predominantly contributed to mortality. Despite improvements, mortality from bacterial diseases and malignant neoplasms has increased, particularly affecting older adults, men, racial minorities, and the western region, requiring targeted interventions to reduce disease burden in vulnerable communities.