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Examining the Effect of Missing Data and Unmeasured Confounding on External Comparator Studies: Case Studies and Simulations. 检验缺失数据和未测量混杂因素对外部比较研究的影响:案例研究与模拟
IF 5.4 2区 医学 Q1 PHARMACOLOGY & PHARMACY Pub Date : 2024-12-01 Epub Date: 2024-08-05 DOI: 10.1007/s40264-024-01467-9
Gerd Rippin, Héctor Sanz, Wilhelmina E Hoogendoorn, Nicolás M Ballarini, Joan A Largent, Eleni Demas, Douwe Postmus, Theodor Framke, Lukas M Aguirre Dávila, Chantal Quinten, Francesco Pignatti

Background and objective: Missing data and unmeasured confounding are key challenges for external comparator studies. This work evaluates bias and other performance characteristics depending on missingness and unmeasured confounding by means of two case studies and simulations.

Methods: Two case studies were constructed by taking the treatment arms from two randomised controlled trials and an external real-world data source that exhibited substantial missingness. The indications of the randomised controlled trials were multiple myeloma and metastatic hormone-sensitive prostate cancer. Overall survival was taken as the main endpoint. The effects of missing data and unmeasured confounding were assessed for the case studies by reporting estimated external comparator versus randomised controlled trial treatment effects. Based on the two case studies, simulations were performed broadening the settings by varying the underlying hazard ratio, the sample size, the sample size ratio between the experimental arm and the external comparator, the number of missing covariates and the percentage of missingness. Thereby, bias and other performance metrics could be quantified dependent on these factors.

Results: For the multiple myeloma external comparator study, results were in line with the randomised controlled trial, despite missingness and potential unmeasured confounding, while for the metastatic hormone-sensitive prostate cancer case study missing data led to a low sample size, leading overall to inconclusive results. Furthermore, for the metastatic hormone-sensitive prostate cancer study, missing data in important eligibility criteria led to further limitations. Simulations were successfully applied to gain a quantitative understanding of the effects of missing data and unmeasured confounding.

Conclusions: This exploratory study confirmed external comparator strengths and limitations by quantifying the impact of missing data and unmeasured confounding using case studies and simulations. In particular, missing data in key eligibility criteria were seen to limit the ability to derive the external comparator target analysis population accurately, while simulations demonstrated the magnitude of bias to expect for various settings.

背景和目的:缺失数据和无法测量的混杂因素是外部参照研究面临的主要挑战。这项工作通过两个案例研究和模拟,评估了缺失和未测量混杂的偏差和其他性能特征:方法:通过从两项随机对照试验和一个外部真实世界数据源中提取治疗臂,构建了两项案例研究。随机对照试验的适应症是多发性骨髓瘤和转移性激素敏感性前列腺癌。总生存期是主要终点。通过报告外部参照物与随机对照试验治疗效果的估计值,评估了缺失数据和未测量混杂因素对病例研究的影响。在两个案例研究的基础上,通过改变基本危险比、样本量、实验臂与外部参照物之间的样本量比、缺失协变量数量和缺失百分比,扩大了模拟设置。因此,偏差和其他性能指标可以根据这些因素进行量化:在多发性骨髓瘤外部参照研究中,尽管存在缺失和潜在的未测量混杂因素,但结果与随机对照试验一致,而在转移性激素敏感性前列腺癌病例研究中,缺失数据导致样本量较少,从而导致总体结果不确定。此外,在转移性荷尔蒙敏感性前列腺癌研究中,重要资格标准数据的缺失导致了进一步的局限性。我们成功地应用了模拟方法,从数量上了解了缺失数据和未测量混杂因素的影响:这项探索性研究通过案例研究和模拟,量化了缺失数据和未测量混杂因素的影响,从而确认了外部参照系统的优势和局限性。特别是,关键资格标准中的缺失数据被认为限制了准确推导外部参照系统目标分析人群的能力,而模拟则显示了不同环境下的预期偏差程度。
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引用次数: 0
The impact of a novel color additive for disinfectant wipes on room cleanliness and turnover time. 用于消毒湿巾的新型颜色添加剂对房间清洁度和周转时间的影响。
IF 4.3 3区 医学 Q2 INFECTIOUS DISEASES Pub Date : 2024-12-01 Epub Date: 2024-09-19 DOI: 10.1016/j.ajic.2024.07.009
Olayinka Oremade, Barbara Odac, Jinzy George, Frederick Browne

Background: Contaminated environmental surfaces in the health care setting put patients at risk of acquiring health care-associated infections. Highlight (Kinnos) is a novel color-additive technology for disinfectant wipes that helps users visualize surfaces that have been cleaned by producing a transient color on wiped surfaces that fades off after effective cleaning.

Methods: To quantify the impact of real-time visual feedback on room cleanliness and efficiency, a pre-post quasi-experimental study was conducted by comparing Replicate Organism Detection and Counting (RODAC) plate counts and room turnaround times with and without the use of the color additive.

Results: Compared with the control group of disinfectant alone, disinfection with the color additive resulted in a 69.2% improvement in room cleanliness accompanied by a 5.9% faster room turnover time.

Discussion: As far as we know, this study is the first to publish on the impact of a novel color additive on the environment of care as measured by microbial culturing and room turnaround times, finding advantages in both metrics relative to the status quo.

Conclusions: The use of real-time visual feedback can improve the thoroughness of disinfection cleaning while maintaining operational efficiency.

背景:医疗机构中受污染的环境表面会给病人带来感染医疗相关疾病的风险。Highlight (Kinnos)是一种用于消毒湿巾的新型增色技术,它能在擦拭过的表面产生瞬时颜色,并在有效清洁后褪去,从而帮助用户直观地看到已清洁过的表面:为了量化实时视觉反馈对房间清洁度和效率的影响,我们进行了一项事前-事后准实验研究,比较了使用和不使用颜色添加剂时的重复生物检测和计数(RODAC)平板计数和房间周转时间:结果:与只使用消毒剂的对照组相比,使用颜色添加剂进行消毒后,房间清洁度提高了 69.2%,房间周转时间缩短了 5.9%:讨论:据我们所知,这项研究是第一项通过微生物培养和病房周转时间来衡量新型彩色添加剂对护理环境影响的研究,发现这两项指标相对于现状都有优势:结论:使用实时视觉反馈可以提高消毒清洁的彻底性,同时保持运行效率。
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引用次数: 0
Protective Role of (-)-Epicatechin on Trimethylamine-N-Oxide (TMAO)-Induced Cardiac Hypertrophy via SP1/SIRT1/SUMO1 Signaling Pathway. 表儿茶素通过 SP1/SIRT1/SUMO1 信号通路对三甲胺氧化物 (TMAO) 诱导的心肌肥大的保护作用
IF 4.3 3区 医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-12-01 Epub Date: 2024-10-17 DOI: 10.1007/s12012-024-09932-8
Siting Hong, Jing Lu, Jiaoyan Li, Yingchun Luo, Dongxue Liu, Yuanyuan Jin, Zeng Wang, Yibo Wang, Hao Zhang, Xin Zhang, Yang Li, Haoruo Zhang, Zengxiang Dong, Zhaojun Wang, Lin Lv, Zhaoguang Liang

(-)-Epicatechin (EPI) is beneficial for cardiovascular health. Trimethylamine N-oxide (TMAO), a gut microbe-derived food metabolite, is strongly associated with the risk of cardiovascular diseases. However, the effects and underlying mechanisms of EPI on TMAO-induced cardiac hypertrophy remain unclear. This study aimed to determine whether EPI inhibits TMAO-induced cardiac hypertrophy. Plasma levels of TMAO in control participants and patients with cardiac hypertrophy were measured and analyzed. Male C57BL/6 mice were randomly divided into control group, TMAO group, EPI group and TMAO + EPI group. According to the groups assignments, mice received intraperitoneal (i.p.) injection of normal saline or i.p. injection of TMAO (150 mg/kg/day) for 14 days. The EPI group was given intragastric (i.g.) administration of EPI alone (1 mg/kg/day) for 21 days, and TMAO + EPI group received i.g. administration of EPI for 7 days before starting i.p. injection of TMAO, continuing until the end of the TMAO treatment. Histological analyses of the mice's hearts was accessed by H&E and Masson staining. In vitro, H9c2 cells were induced to hypertrophy by TMAO (10 µM) for 24 h and were pre-treated with or without EPI (10 µM) for 1 h. Protein level of cardiac hypertrophy markers and Sp1/SIRT1/SUMO1 pathway were determined by western blot. The plasma level of TMAO was 2.66 ± 1.59 μmol/L in patients with cardiac hypertrophy and 0.62 ± 0.30 μmol/L in control participants. EPI attenuated TMAO-induced hypertrophy in H9c2 cells. In vivo, TMAO induced cardiac hypertrophy and impaired the cardiac function of mice. Pathological staining showed that TMAO induced cardiac hypertrophy and collagen deposition in mice. EPI treatment improved the cardiac function, inhibited the myocardial hypertrophy induced by TMAO. EPI significantly attenuated the TMAO-induced upregulation of ANP and BNP and the downregulation of SP1, SIRT1 and SUMO1 in vivo and in vitro. EPI may suppress TMAO-induced cardiac hypertrophy by activating the Sp1/SIRT1/SUMO1 signaling pathway.

(-)-表儿茶素(EPI)有益于心血管健康。三甲胺 N-氧化物(TMAO)是一种源自肠道微生物的食物代谢物,与心血管疾病风险密切相关。然而,EPI对TMAO诱导的心脏肥大的影响和潜在机制仍不清楚。本研究旨在确定 EPI 是否能抑制 TMAO 诱导的心脏肥大。研究人员测量并分析了对照组和心肌肥厚患者血浆中的 TMAO 水平。雄性 C57BL/6 小鼠被随机分为对照组、TMAO 组、EPI 组和 TMAO + EPI 组。按照分组,小鼠腹腔注射生理盐水或腹腔注射TMAO(150毫克/千克/天),连续14天。EPI 组单独胃内注射 EPI(1 毫克/千克/天)21 天,TMAO + EPI 组胃内注射 EPI 7 天后开始胃内注射 TMAO,直至 TMAO 治疗结束。通过H&E和Masson染色对小鼠心脏进行组织学分析。在体外,用TMAO(10 µM)诱导H9c2细胞肥大24小时,并用或不用EPI(10 µM)预处理1小时。心脏肥大患者血浆中的TMAO水平为2.66 ± 1.59 μmol/L,对照组为0.62 ± 0.30 μmol/L。EPI 可减轻 TMAO 诱导的 H9c2 细胞肥大。在体内,TMAO诱导小鼠心脏肥大并损害其心脏功能。病理染色显示,TMAO诱导小鼠心脏肥大和胶原沉积。EPI 治疗可改善心功能,抑制 TMAO 诱导的心肌肥厚。在体内和体外,EPI能明显降低TMAO诱导的ANP和BNP的上调以及SP1、SIRT1和SUMO1的下调。EPI可通过激活Sp1/SIRT1/SUMO1信号通路抑制TMAO诱导的心肌肥厚。
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引用次数: 0
Fasting: A Complex, Double-Edged Blade in the Battle Against Doxorubicin-Induced Cardiotoxicity. 禁食:对抗多柔比星诱发的心脏毒性的复杂双刃剑
IF 4.3 3区 医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-12-01 Epub Date: 2024-10-01 DOI: 10.1007/s12012-024-09925-7
Yiming Meng, Jing Sun, Guirong Zhang, Tao Yu, Haozhe Piao

In recent years, there has been a surge in the popularity of fasting as a method to enhance one's health and overall well-being. Fasting is a customary practice characterized by voluntary refraining from consuming food and beverages for a specified duration, ranging from a few hours to several days. The potential advantages of fasting, including enhanced insulin sensitivity, decreased inflammation, and better cellular repair mechanisms, have been well documented. However, the effects of fasting on cancer therapy have been the focus of recent scholarly investigations. Doxorubicin (Dox) is one of the most widely used chemotherapy medications for cancer treatment. Unfortunately, cardiotoxicity, which may lead to heart failure and other cardiovascular issues, has been linked to Dox usage. This study aims to comprehensively examine the possible advantages and disadvantages of fasting concerning Dox-induced cardiotoxicity. Researchers have investigated the potential benefits of fasting in lowering the risk of Dox-induced cardiac damage to solve this problem. Nevertheless, new studies indicate that prolonged alternate-day fasting may adversely affect the heart's capacity to manage the cardiotoxic properties of Dox. Though fasting may benefit overall health, it is essential to proceed cautiously and consider the potential risks in certain circumstances.

近年来,断食作为一种增进健康和整体福祉的方法受到了越来越多人的青睐。断食是一种习惯做法,其特点是在规定的时间内(从几小时到几天不等)自愿不进食和不喝饮料。禁食的潜在优势,包括增强胰岛素敏感性、减少炎症反应和改善细胞修复机制,已被充分记录在案。然而,禁食对癌症治疗的影响是近期学术研究的重点。多柔比星(Dox)是癌症治疗中使用最广泛的化疗药物之一。不幸的是,心脏毒性(可能导致心力衰竭和其他心血管问题)与 Dox 的使用有关。本研究旨在全面探讨禁食对 Dox 引起的心脏毒性的利弊。为了解决这一问题,研究人员已经调查了禁食对降低 Dox 引起的心脏损伤风险的潜在益处。然而,新的研究表明,长期隔日禁食可能会对心脏控制 Dox 的心脏毒性的能力产生不利影响。虽然禁食可能有益于整体健康,但在某些情况下必须谨慎行事并考虑潜在风险。
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引用次数: 0
SYT7 as a Potential Prognostic Marker Promotes the Metastasis of Epithelial Ovarian Cancer Cells by Activating the STAT3 Pathway. 作为潜在预后标志物的 SYT7 通过激活 STAT3 通路促进上皮性卵巢癌细胞的转移
IF 4.3 2区 医学 Q3 BIOCHEMISTRY & MOLECULAR BIOLOGY Pub Date : 2024-12-01 Epub Date: 2024-09-27 DOI: 10.1002/mc.23821
Yinguang Li, Fengping Shao, Ying Huang, Qian Yin, Jun Liu, Yunhe Zhao, Linjing Yuan

The study aimed to investigate the impact of synaptotagmin 7 (SYT7) on the metastasis of epithelial ovarian cancer (EOC) and its potential mechanisms. This was achieved through the analysis of SYT7 expression levels and clinical relevance in EOC using bioinformatics analysis from TCGA. Additionally, the study examined the influence of SYT7 on the migration and invasion of EOC cells, as well as explored its molecular mechanisms using in vitro EOC cell lines and in vivo mouse xenograft models. Our research revealed that human EOC tissues exhibit significantly elevated levels of SYT7 compared to normal ovarian tissues, and that SYT7 expression is inversely correlated with overall survival. Suppression of SYT7 effectively impeded the migratory and invasive capabilities of CAOV3 cells, whereas overexpression of SYT7 notably accelerated tumor progression in A2780 cells. Mechanistic investigations demonstrated that SYT7 upregulates p-STAT3 and MMP2 in EOC cells. Importantly, treatment with the STAT3 inhibitor niclosamide effectively counteracted the oncogenic effects of SYT7 in EOC. The inhibition of SYT7 was found to significantly reduce in vivo tumor metastasis in a nude mouse xenograft model. Our findings suggest that the upregulation of SYT7 in EOC is associated with a negative prognosis, as it enhances tumor migration and invasion by activating the STAT3 signaling pathway. Thus, SYT7 might be utilized as a EOC prognostic marker and treatment target.

该研究旨在探讨突触表位素7(SYT7)对上皮性卵巢癌(EOC)转移的影响及其潜在机制。为此,研究人员利用 TCGA 的生物信息学分析方法,分析了 SYT7 在 EOC 中的表达水平和临床相关性。此外,研究还考察了SYT7对EOC细胞迁移和侵袭的影响,并利用体外EOC细胞系和体内小鼠异种移植模型探索了其分子机制。我们的研究发现,与正常卵巢组织相比,人类EOC组织的SYT7水平明显升高,而且SYT7的表达与总生存率成反比。抑制SYT7能有效抑制CAOV3细胞的迁移和侵袭能力,而过表达SYT7则会明显加速A2780细胞的肿瘤进展。机理研究表明,SYT7 能上调 EOC 细胞中的 p-STAT3 和 MMP2。重要的是,STAT3抑制剂尼可刹米能有效抵消SYT7在EOC中的致癌作用。在裸鼠异种移植模型中,发现抑制SYT7能显著减少体内肿瘤转移。我们的研究结果表明,SYT7在EOC中的上调与不良预后有关,因为它通过激活STAT3信号通路来增强肿瘤的迁移和侵袭。因此,SYT7可作为EOC预后标志物和治疗靶点。
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引用次数: 0
BNST CRF receptor type 1 modulates mechanical hypersensitivity induced by adolescent alcohol exposure in adult female mice. BNST CRF 受体 1 型可调节成年雌性小鼠因青春期酒精暴露而诱发的机械超敏反应。
IF 4.3 3区 医学 Q2 NEUROSCIENCES Pub Date : 2024-12-01 Epub Date: 2024-09-30 DOI: 10.1007/s00213-024-06693-8
Natalia B Bertagna, Eleanor B Holmgren, Sheila A Engi, Linh Ha, Fabio C Cruz, Lucas Albrechet-Souza, Tiffany A Wills

Rationale: Alcohol exposure during adolescence has been linked to long-lasting behavioral consequences, contributing to the development of alcohol use disorder. Negative affect and chronic pain during alcohol withdrawal are critical factors influencing problematic alcohol use and relapse. Our previous research demonstrated that adolescent intermittent ethanol (AIE) vapor exposure elicits sex-specific negative affect-like behavior in adult mice following stress exposure. Additionally, AIE induces persistent mechanical hypersensitivity, which is accompanied by increased activation of corticotropin-releasing factor receptor type 1 (CRFR1) neurons in the dorsolateral bed nucleus of the stria terminalis (dlBNST).

Objectives: This study extends previous work by investigating plasma corticosterone levels and CRFR1 protein expression in the dlBNST following restraint stress exposure in adult mice with an AIE history. We also aim to explore the role of dlBNST CRFR1 signaling in mediating negative affect-like behavior and mechanical hypersensitivity.

Results: Female mice exhibited elevated plasma corticosterone levels compared to males following restraint stress. Moreover, females with AIE history showed higher expression of CRFR1 protein in the dlBNST compared to air controls. Antagonism of CRFR1 in the dlBNST blocked AIE-induced mechanical hypersensitivity in adult females but did not affect stress-induced negative affect-like behavior. In alcohol-naïve females, intra-dlBNST administration of a CRFR1 agonist induced mechanical hypersensitivity.

Conclusions: These findings provide new insights into the neurobiological mechanisms underlying stress-induced negative affect and pain-related behavior, both influenced by a history of adolescent alcohol exposure. The results suggest that CRFR1 antagonists warrant further investigation for their potential in addressing alcohol-related chronic pain.

理由青少年时期接触酒精与长期的行为后果有关,会导致酒精使用障碍的发展。酒精戒断期间的负面情绪和慢性疼痛是影响问题酒精使用和复发的关键因素。我们之前的研究表明,青春期间歇性乙醇(AIE)蒸汽暴露会诱发成年小鼠在应激暴露后出现性别特异性的类似负性情绪的行为。此外,间歇性乙醇蒸汽暴露会诱发持续性机械过敏,并伴随着激活纹状体末端背外侧床核(dlBNST)中促肾上腺皮质激素释放因子受体1型(CRFR1)神经元的增加:本研究扩展了之前的工作,调查了有AIE病史的成年小鼠在受到束缚应激后血浆皮质酮水平和dlBNST中CRFR1蛋白的表达情况。我们还旨在探索 dlBNST CRFR1 信号在介导负性情感样行为和机械过敏中的作用:结果:与雄性小鼠相比,雌性小鼠在束缚应激后表现出血浆皮质酮水平升高。此外,与空气对照组相比,有 AIE 病史的雌性小鼠在 dlBNST 中的 CRFR1 蛋白表达更高。在dlBNST中拮抗CRFR1可阻断AIE诱导的成年雌性机械过敏,但不会影响应激诱导的负情感行为。在未饮酒的雌性中,在dlBNST内给予CRFR1激动剂可诱导机械过敏:这些研究结果为了解应激诱导的负性情绪和疼痛相关行为的神经生物学机制提供了新的视角。结果表明,CRFR1 拮抗剂在解决与酒精相关的慢性疼痛方面的潜力值得进一步研究。
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引用次数: 0
Charting a National Path for Well-Being Through Healthy People 2030. 通过 "2030 年健康人民 "规划国家福祉之路。
IF 4.3 2区 医学 Q1 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-12-01 Epub Date: 2024-07-17 DOI: 10.1097/MLR.0000000000002034
Deborah Hoyer, Emmeline Ochiai, Carter Blakey

The Office of Disease Prevention and Health Promotion (ODPHP) at the US Department of Health and Human Services (HHS) oversees Healthy People 2030, the nation's decennial health promotion and disease prevention framework and plan, which sets national goals and identifies science-based measurable objectives with targets to evaluate efforts to improve health and well-being. With science recognizing the relationship between health and well-being, Healthy People 2030 is broadening its understanding of national-level well-being by gathering new data for and coordinating across the federal government on well-being. The addition of well-being in Healthy People 2030 elevates well-being as a national priority and creates opportunities for the well-being of the nation to be assessed, disparities to be identified, and collaborative efforts to be coordinated to support a society in which all people can achieve their full potential for health and well-being. This article discusses the inclusion of well-being to Healthy People 2030, details the approach and rationale for the selection of the national well-being metrics, and articulates opportunities for improving population-level well-being and federal collaboration.

美国卫生与公众服务部(HHS)疾病预防与健康促进办公室(ODPHP)负责监督 "健康2030"(Healthy People 2030)这一国家十年期健康促进与疾病预防框架和计划的实施,该计划设定了国家目标,并确定了以科学为基础的可衡量目标,以及评估改善健康和福祉工作的指标。随着科学界认识到健康与福祉之间的关系,"健康2030 "正在通过收集新的数据和协调联邦政府在福祉方面的工作,扩大对国家层面福祉的理解。在 "健康2030 "中增加福祉内容,将福祉提升为国家优先事项,并为评估国家福祉、发现差距和协调合作创造了机会,以支持建立一个所有人都能充分发挥健康和福祉潜力的社会。本文讨论了将福祉纳入 "健康2030 "的问题,详细介绍了选择国家福祉指标的方法和理由,并阐述了改善人口层面福祉和联邦合作的机会。
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引用次数: 0
Planned Home Births in the United States Have Outcomes Comparable to Planned Birth Center Births for Low-Risk Birthing Individuals. 美国计划内家庭分娩与计划内分娩中心分娩对低风险分娩者的效果相当。
IF 4.3 2区 医学 Q1 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-12-01 Epub Date: 2024-11-08 DOI: 10.1097/MLR.0000000000002074
Marit L Bovbjerg, Melissa Cheyney, Lauren Hoehn-Velasco, Diana Jolles, Jennifer Brown, Jennifer Stapleton, Courtney Everson, Susan Stapleton, Saraswathi Vedam

Objective: There are lingering concerns in the United States about home birth. We used 2 large (n = 50,043; n = 62,984), national community birth registries to compare maternal and neonatal outcomes for planned home versus planned birth center births.

Methods: To compare outcomes by intended birth site, we used logistic regressions, controlling for demographic and pregnancy risk variables. Maternal outcomes included intrapartum or postpartum transfer to hospital, hospitalization, cesarean, and hemorrhage; neonatal outcomes included neonatal transfer, hospitalization, neonatal intensive care unit admission, and intrapartum or neonatal death. Analyses were conducted twice, once in each dataset.

Results: Individuals who planned home births had a lower incidence of all types of transfers, compared with those who planned birth center births, but in one dataset only, experienced more cesareans [adjusted odds ratio (95% CI): 1.32 (1.02-1.70); 0.95 (0.88-1.03)]. Planned home birth was associated with lower adjusted odds of maternal hospitalization in one dataset but not the other [0.97 (0.54-1.74); 0.85 (0.76-0.95)], and was not associated with hemorrhage. Neonatal outcomes likewise were either not associated with a planned birthplace or suggested home birth was safer: hospitalization [0.77 (0.53-1.11), 0.90 (0.82-0.98)], neonatal intensive care unit admission [0.54 (0.28-1.00), 0.97 (0.86-1.10)]. There was no observable association with intrapartum or neonatal death: 1.07 (0.68-1.67; only calculated once because of small numbers of events).

Conclusions: Planned home births are as safe as planned birth center births for low-risk pregnancies. Current guidelines advising against planned home births are not supported by these data.

目的:在美国,人们对在家分娩的担忧挥之不去。我们利用两个大型(n = 50,043; n = 62,984)全国性社区出生登记,比较了计划在家中分娩与计划在分娩中心分娩的产妇和新生儿结局:为了比较不同计划分娩地点的结果,我们使用了逻辑回归法,并控制了人口统计学和妊娠风险变量。产妇结局包括产中或产后转院、住院、剖宫产和大出血;新生儿结局包括新生儿转院、住院、入住新生儿重症监护室和产中或新生儿死亡。分析进行了两次,每个数据集一次:结果:与计划在分娩中心分娩的产妇相比,计划在家中分娩的产妇所有类型的转院发生率都较低,但仅在一个数据集中,计划在家中分娩的产妇经历了更多的剖宫产[调整后的几率比(95% CI):1.32(1.02-1.70);0.95(0.88-1.03)]。在一个数据集中,计划在家分娩与产妇住院的调整后几率较低有关[0.97 (0.54-1.74); 0.85 (0.76-0.95)],但与大出血无关。新生儿结局同样与计划分娩地点无关或表明在家分娩更安全:住院[0.77 (0.53-1.11), 0.90 (0.82-0.98)], 入住新生儿重症监护室[0.54 (0.28-1.00), 0.97 (0.86-1.10)]。与产中死亡或新生儿死亡无明显关联:1.07(0.68-1.67;由于事件数量少,只计算了一次):结论:对于低风险妊娠,计划内家庭分娩与计划内分娩中心分娩一样安全。这些数据并不支持目前建议不要在家中计划分娩的指导方针。
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引用次数: 0
Evaluation of Four Multispecies Probiotic Cocktails in a Human Colonic Fermentation Model. 人类结肠发酵模型中四种多菌种益生菌鸡尾酒的评价。
IF 5.4 2区 生物学 Q1 BIOTECHNOLOGY & APPLIED MICROBIOLOGY Pub Date : 2024-12-01 Epub Date: 2023-09-19 DOI: 10.1007/s12602-023-10162-7
Elizabeth Goya-Jorge, Irma Gonza, Pauline Bondue, Germain Druart, Mohamed Al-Chihab, Samiha Boutaleb, Caroline Douny, Marie-Louise Scippo, Philippe Thonart, Véronique Delcenserie

Bacteriotherapy represents an attractive approach for both prophylaxis and treatment of human diseases. However, combining probiotic bacteria in "cocktails" is underexplored, despite its potential as an alternative multi-target therapy. Herein, three-strain probiotic mixtures containing different combinations of Bacillus (Bc.) coagulans [ATB-BCS-042], Levilactobacillus (Lv.) brevis [THT 0303101], Lacticaseibacillus (Lc.) paracasei [THT 031901], Bacillus subtilis subsp. natto [ATB-BSN-049], Enterococcus faecium [ATB-EFM-030], and Bifidobacterium (Bf.) animalis subsp. lactis [THT 010802] were prepared. Four cocktails (PA: Bc. coagulans + Lv. brevis + Lc. paracasei, PB: Bc. subtilis subsp. natto + Lv. brevis + Lc. paracasei, PC: E. faecium + Lv. brevis + Lc. paracasei, PD: Bc. coagulans + Lv. brevis + Bf. animalis subsp. lactis) were tested using a short-term (72 h) simulation of the human colonic microbiota in a final dose of 6 × 109 CFU. All these probiotic mixtures significantly increased butyrate production compared to the parallel control experiment. PA and PB promoted a bifidogenic effect and facilitated lactobacilli colonization. Furthermore, reporter gene assays using the AhR_HT29-Lucia cell line revealed that fermentation supernatants from PA and PB notably induced AhR transactivity. Subsequent examination of the metabolic outputs of PA and PB in intestinal epithelial models using cell culture inserts suggested no significant impact on the transepithelial electrical resistance (TEER). Assessment of the expression of proinflammatory and anti-inflammatory cytokines, as well as AhR-related target genes in the Caco-2 cell monolayers indicated that PB's metabolic output upregulated most of the measured endpoints. This in vitro investigation evaluated the potential impact of four multispecies probiotic mixtures in the human colonic microbiota and identified a promising formulation comprising a combination of Bc. subtilis subsp. natto, Lv. brevis, and Lc. paracasei as a promising formulation for further study.

细菌疗法是预防和治疗人类疾病的一种有吸引力的方法。然而,将益生菌组合在“鸡尾酒”中却没有得到充分的探索,尽管它有可能成为一种替代的多靶点疗法。本文中,三种菌株的益生菌混合物含有凝结芽孢杆菌[ATB-BCS-042]、短乳杆菌(Lv.)[THT0303101]、副干酪乳杆菌[THT031901]、枯草芽孢杆菌亚种。纳豆[ATB-BSN-049]、粪肠球菌[ATB-EFM-030]和动物双歧杆菌亚种。制备了丙交酯[THT010802]。四杯鸡尾酒(PA:Bc.凝固剂 + Lv.brevis + 副干酪乳杆菌,PB:Bc。枯草芽孢杆菌亚种。纳豆 + Lv.brevis + 副干酪乳杆菌,PC:粪大肠杆菌 + Lv.brevis + 副casei,PD:Bc。凝固剂 + Lv.brevis + 动物亚种。乳糖)在6的最终剂量下使用人类结肠微生物群的短期(72小时)模拟进行测试 × 109 CFU。与平行对照实验相比,所有这些益生菌混合物显著增加了丁酸盐的产量。PA和PB促进了双歧作用并促进了乳酸杆菌的定植。此外,使用AhR_HT29-Lucia细胞系的报告基因测定显示,来自PA和PB的发酵上清液显著诱导了AhR反式活性。随后使用细胞培养插入物对肠上皮模型中PA和PB的代谢输出进行的检查表明,对跨上皮电阻(TEER)没有显著影响。对Caco-2细胞单层中促炎和抗炎细胞因子以及AhR相关靶基因表达的评估表明,PB的代谢输出上调了大多数测量终点。这项体外研究评估了四种多品种益生菌混合物对人类结肠微生物群的潜在影响,并确定了一种含有Bc组合的有前景的制剂。枯草芽孢杆菌亚种。纳豆、Lv.brevis和Lc.paracasei是一种有前景的进一步研究配方。
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引用次数: 0
Nutritional practices to manage menstrual cycle related symptoms: a systematic review. 管理月经周期相关症状的营养实践:一项系统综述。
IF 8.3 2区 医学 Q1 NUTRITION & DIETETICS Pub Date : 2024-12-01 Epub Date: 2023-09-25 DOI: 10.1017/S0954422423000227
Natalie Brown, Daniel Martin, Mark Waldron, Georgie Bruinvels, Lucy Farrant, Ruth Fairchild

Certain nutritional practices may reduce menstrual-related symptoms, but there is no current consensus on what foods/supplements are sufficiently evidenced to warrant promotion to reduce menstrual symptoms of naturally menstruating individuals. This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Two online databases were searched for published experimental studies that investigated the effects of foods/supplements on menstrual-related symptoms in eumenorrhoeic women. Extracted data and study characteristics were tabulated and grouped on the basis of food/supplement intervention and dosage compared with UK dietary reference values (DRV) and safe upper limits. In total, twenty-eight studies and twenty-one different foods/supplement interventions were included in the review. None of the studies reported a negative effect on symptoms, twenty-three reported a positive effect and five had no effect. Eighteen different ways of measuring menstrual-related symptoms were described across the studies. The results indicate a lack of consistency in studies to confidently provide information to eumenorrheic, naturally menstruating women regarding the use of foods/supplements to reduce menstrual symptoms. Determination of menstrual-related symptoms varied along with dose and duration of food or supplements provided. These data provide some evidence for the use of vitamin D, calcium, zinc and curcumin to reduce menstrual-related symptoms of non-hormonal contraceptive users, on an individual basis; however, further investigation is required prior to implementation with a focus on robust protocols to determine and measure changes in menstrual symptoms, with interventions adhering to DRV and safe upper limits.

某些营养实践可能会减少月经相关症状,但目前还没有达成共识,即哪些食物/补充剂有足够的证据证明有必要推广,以减少自然月经来潮者的月经症状。本综述遵循了系统评价和荟萃分析(PRISMA)指南的首选报告项目。在两个在线数据库中搜索了已发表的实验研究,这些研究调查了食物/补充剂对月经异常女性月经相关症状的影响。根据与英国饮食参考值(DRV)和安全上限相比的食品/补充剂干预和剂量,将提取的数据和研究特征制成表格并分组。共有28项研究和21种不同的食品/补充剂干预措施被纳入审查。没有一项研究报告对症状有负面影响,23项报告有正面影响,5项没有影响。研究中描述了18种不同的测量月经相关症状的方法。研究结果表明,研究缺乏一致性,无法自信地向月经正常、自然来潮的女性提供关于使用食物/补充剂来减轻月经症状的信息。月经相关症状的确定随着所提供食物或补充剂的剂量和持续时间而变化。这些数据为使用维生素D、钙、锌和姜黄素在个体基础上减少非激素避孕药使用者的月经相关症状提供了一些证据,但在实施之前需要进一步调查,重点是确定和测量月经症状变化的有力方案,干预措施应遵守DRV和安全上限。
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引用次数: 0
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