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Neuroinflammatory Responses and Blood–Brain Barrier Injury in Chronic Alcohol Exposure: Role of Purinergic P2X7 Receptor Signaling 慢性酒精暴露中的神经炎症反应和血脑屏障损伤:嘌呤能 P2X7 受体信号的作用
Pub Date : 2024-05-08 DOI: 10.21203/rs.3.rs-4350949/v1
Namdev S Togre, Naveen Melaka, Priyanka Bhoj, Nikhita Mogadala, Malika Winfield, Jayshil Trivedi, Deborah Grove, Sudhir Kotnala, Slava Rom, Uma Sri, Yuri Persidsky
Abstract Alcohol consumption leads to neuroinflammation and blood‒brain barrier (BBB) damage, resulting in neurological impairment. We previously demonstrated that ethanol-induced disruption of barrier function in human brain endothelial cells was associated with mitochondrial injury, increased ATP and extracellular vesicle (EV) release, and purinergic receptor P2X7R activation. Therefore, we aimed to evaluate the effect of P2X7r blockade on peripheral and neuro-inflammation in EtOH-exposed mice. In a chronic intermittent ethanol (CIE)-exposed mouse model, P2X7R was inhibited by two different methods: Brilliant Blue G (BBG) or gene knockout. We assessed blood ethanol concentration (BEC), plasma P2X7R and P-gp, number of extra-cellular vesicles (EV), serum ATP and EV-ATP levels. Brain microvessel gene expression and EV mtDNA copy numbers were measured by RT2 PCR array and digital PCR, respectively. A RT2 PCR array of brain microvessels revealed significant upregulation of proinflammatory genes involved in apoptosis, vasodilation, and platelet activation in CIE-exposed animals, which were decreased 15–50-fold in BBG-treated CIE-exposed animals. Plasma P-gp levels and serum P2X7R shedding were significantly increased in CIE-exposed animals. Pharmacological or genetic suppression of P2X7R decreased P2X7R shedding to levels equivalent to those in control group. The increase in EV number and EV-ATP content in the CIE-exposed mice was significantly reduced by P2X7R inhibition. CIE mice showed augmented EV-mtDNA copy numbers which were reduced in EVs after P2X7R inhibition or receptor knockout. These observations suggested that P2X7R signaling plays a critical role in ethanol-induced brain injury. Increased eATP, EV-ATP, EV numbers, and EV-mtDNA copy numbers highlight a new mechanism of brain injury during alcohol exposure via P2X7R and biomarkers of such damage. In this study, for the first time, we report the in vivo involvement of P2X7R signaling in CIE-induced brain injury.
摘要 酒精会导致神经炎症和血脑屏障(BBB)损伤,从而造成神经功能损害。我们以前曾证实,乙醇诱导的人脑内皮细胞屏障功能破坏与线粒体损伤、ATP 和细胞外囊泡 (EV) 释放增加以及嘌呤能受体 P2X7R 激活有关。因此,我们旨在评估阻断 P2X7r 对暴露于乙醇的小鼠外周和神经炎症的影响。在慢性间歇性乙醇(CIE)暴露小鼠模型中,我们采用了两种不同的方法抑制 P2X7R:亮蓝 G (BBG) 或基因敲除。我们评估了血液乙醇浓度(BEC)、血浆 P2X7R 和 P-gp、细胞外囊泡(EV)数量、血清 ATP 和 EV-ATP 水平。脑微血管基因表达和EV mtDNA拷贝数分别通过RT2 PCR阵列和数字PCR检测。脑微血管的RT2 PCR阵列显示,在CIE暴露的动物中,参与细胞凋亡、血管舒张和血小板活化的促炎基因显著上调,而在BBG处理的CIE暴露动物中,这些基因上调减少了15-50倍。CIE暴露动物的血浆P-gp水平和血清P2X7R脱落显著增加。药物或基因抑制P2X7R可将P2X7R脱落降至与对照组相同的水平。抑制P2X7R后,暴露于CIE的小鼠体内EV数量和EV-ATP含量的增加明显减少。CIE小鼠的EV-mtDNA拷贝数增加,而P2X7R抑制或受体敲除后EV中的拷贝数减少。这些观察结果表明,P2X7R 信号在乙醇诱导的脑损伤中起着关键作用。eATP、EV-ATP、EV数量和EV-mtDNA拷贝数的增加凸显了酒精暴露期间通过P2X7R和生物标志物造成脑损伤的新机制。在这项研究中,我们首次报告了 P2X7R 信号在体内参与 CIE 诱导的脑损伤。
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引用次数: 0
Guiding the Implementation of Wastewater-based Surveillance for Carceral Infection Control with Perspectives from People with Lived Experience of Incarceration during the COVID-19 Pandemic 以 COVID-19 大流行期间有监禁经历者的视角指导实施基于废水的监测以控制殡葬感染
Pub Date : 2024-05-08 DOI: 10.21203/rs.3.rs-4214768/v1
Victoria M. Brown, Emily A. Ogutu, Alexandra E. Kauffman, Shanika S. Kennedy, Rebecca A. Tenner, A. Wurcel, Chad J. Zawitz, Anne C Spaulding, Matthew J. Akiyama
Abstract Background Little guidance exists on best practices for implementing and sustaining wastewater-based surveillance (WBS) for SARS-CoV-2 in carceral settings. To ensure alignment with priorities of stakeholders, we aimed to understand the perspectives of persons with lived experience (PLE) of jail who were incarcerated during the height of the COVID-19 pandemic on infection control. Methods We recruited two PLE at each of four jails: Cook County (IL), Fulton County (GA), Middlesex County (MA), and Washington DC. Focus Group Discussion (FGD) guides followed the Consolidated Framework for Implementation Research (CFIR). Two FGDs focusing on lived experience with jail infection control protocol and WBS were conducted, and six Key Informant (KI) interviews followed to gain insights on communicating WBS results. We used a combination of deductive thematic analysis based on CFIR constructs and inductive analysis to capture emergent themes. Results Themes from FGDs included: (1) variable experiences with COVID-19 infection control protocols including intake processes, individual testing, isolation and quarantine, (2) the perceived attitudes of fellow residents and staff surrounding COVID-19 mitigation in a carceral setting; and (3) perceived benefits and challenges involving WBS implementation and messaging. KIs emphasized 1) The importance of straightforward health messaging and trustworthiness in the communication of WBS results, 2) Support for enhanced health education around outbreaks, and 3) Receptiveness to WBS being used as a tool to measure common infectious agents (i.e., influenza) but hesitancy regarding its application to conditions such as HIV and illicit drug use. PLE articulated support of robust infection control programs and receptiveness to expanding WBS if conducted in a non-stigmatizing manner. Conclusion Perspectives from PLE can help shape the infection control programs for future outbreaks and inform the expansion of WBS implementation in carceral facilities. It will be important to consider the voices of current and former residents, as receivers of care, to promote an environment conducive to comprehensive infection control. In addition to having infection control programs consistently execute set protocols and educate all stakeholders, PLE identified collaboration between jail staff and residents, and clear communication around program expectations as priorities. Findings from this qualitative study can be shared with jail decision makers and the perceived engagement of stakeholders can be measured.
摘要 背景 关于在监狱环境中实施和维持基于废水的 SARS-CoV-2 监控 (WBS) 的最佳实践指导很少。为确保与利益相关者的优先事项保持一致,我们旨在了解在 COVID-19 大流行期间被监禁的监狱亲历者 (PLE) 对感染控制的看法。方法 我们在四所监狱各招募了两名 PLE:库克县(伊利诺伊州)、富尔顿县(佐治亚州)、米德尔塞克斯县(马萨诸塞州)和华盛顿特区。焦点小组讨论 (FGD) 指南遵循实施研究综合框架 (CFIR)。我们进行了两次 FGD,重点讨论了监狱感染控制协议和 WBS 的生活经验,随后进行了六次关键知情人 (KI) 访谈,以了解 WBS 结果的传播情况。我们结合使用了基于 CFIR 结构的演绎式主题分析和归纳式分析来捕捉新出现的主题。结果 FGD 的主题包括(1) 对 COVID-19 感染控制协议的不同体验,包括入院流程、个人检测、隔离和检疫;(2) 在囚禁环境中,居民和工作人员对减轻 COVID-19 感染的认知态度;(3) 对 WBS 实施和信息传达方面的益处和挑战的认知。KIs 强调:1)在传达 WBS 结果时,直截了当的健康信息和可信度非常重要;2)支持围绕疾病暴发加强健康教育;3)接受将 WBS 用作测量常见传染病病原体(如流感)的工具,但对其是否适用于 HIV 和非法使用毒品等情况犹豫不决。PLE 明确表示支持强有力的感染控制计划,并接受以非污名化的方式扩大 WBS 的应用范围。结论 PLE 的观点有助于为未来的疫情爆发制定感染控制计划,并为在囚禁设施中扩大 WBS 的实施范围提供信息。重要的是要考虑到作为护理接受者的现任和前任居民的意见,以促进有利于全面感染控制的环境。除了让感染控制项目始终如一地执行既定协议并对所有利益相关者进行教育外,PLE 还将监狱工作人员与居民之间的合作以及围绕项目期望的明确沟通确定为优先事项。这项定性研究的结果可与监狱决策者分享,并可衡量利益相关者的参与度。
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引用次数: 0
Programable Albumin-Hitchhiking Nanobodies Enhance the Delivery of STING Agonists to Potentiate Cancer Immunotherapy 可编程白蛋白搭便车纳米抗体能增强 STING 激动剂的递送,从而提高癌症免疫疗法的疗效
Pub Date : 2024-05-08 DOI: 10.21203/rs.3.rs-3243545/v1
John Wilson, Blaise R. Kimmel, Karan Arora, Neil Chada, Vijaya Bharti, Alexander J Kwiatkowski, Jonah Finklestein, Ann Hanna, Emily Arner, Taylor L. Sheehy, L. Pastora, Jinming Yang, Hayden M Pagendarm, P. Stone, Brandie Taylor, Lauren Hubert, Kathern Gibson-Corley, Jody May, John McLean, Jeffrey Rathmell, Ann Richmond, Wendy Rathmell, Justin Balko, Barbara Fingleton, Ebony Hargrove-Wiley
Abstract Stimulator of interferon genes (STING) is a promising target for potentiating antitumor immunity, but multiple pharmacological barriers limit the clinical utility, efficacy, and/or safety of STING agonists. Here we describe a modular platform for systemic administration of STING agonists based on nanobodies engineered for in situ hitchhiking of agonist cargo on serum albumin. Using site-selective bioconjugation chemistries to produce molecularly defined products, we found that covalent conjugation of a STING agonist to anti-albumin nanobodies improved pharmacokinetics and increased cargo accumulation in tumor tissue, stimulating innate immune programs that increased the infiltration of activated natural killer cells and T cells, which potently inhibited tumor growth in multiple mouse tumor models. We also demonstrated the programmability of the platform through the recombinant integration of a second nanobody domain that targeted programmed cell death ligand-1 (PD-L1), which further increased cargo delivery to tumor sites while also blocking immunosuppressive PD-1/PD-L1 interactions. This bivalent nanobody carrier for covalently conjugated STING agonists stimulated robust antigen-specific T cell responses and long-lasting immunological memory, conferred enhanced therapeutic efficacy, and was effective as a neoadjuvant treatment for improving responses to adoptive T cell transfer therapy. Albumin-hitchhiking nanobodies thus offer an enabling, multimodal, and programmable platform for systemic delivery of STING agonists with potential to augment responses to multiple immunotherapeutic modalities.
摘要 干扰素基因刺激器(STING)是增强抗肿瘤免疫力的有望靶点,但多种药理学障碍限制了 STING 激动剂的临床实用性、有效性和/或安全性。在这里,我们介绍了一种用于全身给药 STING 激动剂的模块化平台,该平台以纳米抗体为基础,可使激动剂货物原位搭乘血清白蛋白。我们发现,将 STING 激动剂与抗白蛋白纳米抗体共价结合可改善药代动力学并增加货物在肿瘤组织中的积聚,刺激先天性免疫程序,增加活化的自然杀伤细胞和 T 细胞的浸润,从而有效抑制多种小鼠肿瘤模型中的肿瘤生长。我们还通过重组整合针对程序性细胞死亡配体-1(PD-L1)的第二个纳米抗体结构域,证明了该平台的可编程性,从而进一步增加了向肿瘤部位的货物输送,同时还阻断了免疫抑制性 PD-1/PD-L1 的相互作用。这种用于共价共轭 STING 激动剂的二价纳米抗体载体能激发强大的抗原特异性 T 细胞反应和持久的免疫记忆,增强疗效,并能有效作为新辅助治疗手段,改善对采用 T 细胞转移疗法的反应。因此,白蛋白搭桥纳米抗体为 STING 激动剂的全身给药提供了一个有利的、多模式的和可编程的平台,具有增强多种免疫治疗模式反应的潜力。
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引用次数: 0
Cost-utility analysis of community-based interventions for hypertension control in Vietnam 越南高血压控制社区干预的成本效益分析
Pub Date : 2024-05-07 DOI: 10.21203/rs.3.rs-4328156/v1
Viet Nguyen, D. Ha, O. M. Tran, Hoa L. Nguyen, Robert J. Goldberg, J. Allison, Neil S. Fleming, Phuong Khanh Nguyen
Abstract Between 2010 and 2011, stakeholders implemented a multi-faceted community-based intervention in response to the escalating issue of uncontrolled hypertension in Hung Yen province, Vietnam. This initiative integrated expanded community health worker services, home blood pressure self-monitoring, and a unique "storytelling intervention" into routine clinical care. From the limited societal perspective, our study evaluates the cost-effectiveness of this intervention using a Markov model with a one-year cycle over a lifetime horizon. The analysis, based on a cohort of 671 patients, reveals a lifetime incremental cost of approximately VND 90.37 million (USD 3,930) per quality-adjusted life year (QALY) gained. With a willingness to pay at three times GDP (VND 259.2 million per QALY), the intervention proves cost-effective 80% of the time. This research underscores the potential of the community-based approach to effectively control hypertension, offering valuable insights into its broader implications for public health.
摘要 2010 年至 2011 年间,针对越南洪燕省日益严重的高血压失控问题,各利益相关方实施了一项以社区为基础的多方面干预措施。这项措施将扩大社区保健员服务、家庭血压自我监测和独特的 "讲故事干预 "纳入常规临床护理。从有限的社会角度出发,我们的研究使用马尔可夫模型评估了这一干预措施的成本效益。基于 671 名患者的队列分析显示,每获得一个质量调整生命年(QALY)的终生增量成本约为 9,037 万越南盾(3,930 美元)。由于支付意愿为国内生产总值的三倍(每质量调整生命年 2.592 亿越南盾),因此该干预措施在 80% 的情况下具有成本效益。这项研究强调了以社区为基础的方法在有效控制高血压方面的潜力,为其对公共卫生的广泛影响提供了宝贵的见解。
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引用次数: 0
Serving Up FLAN. A Food Literacy and Nutrition Intervention to Fend Off Food Insecurity. 服务于 FLAN。食品知识和营养干预措施,抵御食品不安全。
Pub Date : 2024-05-07 DOI: 10.21203/rs.3.rs-4331290/v1
Michael F. Royer, Michelle E. Hauser, Astrid N Zamora, Maria I. Campero, Dulce M. Garcia, Martha Gabaray, Jylana L. Sheats, Abby C. King
Abstract Background: Food insecurity, an ongoing and accelerating problem in the U.S., is an economic and social condition involving limited or uncertain access to adequate food. Some of the highest rates of food insecurity in 2022 were found among individuals who were Hispanic-Latinx (20.8%), a population that already faces disproportionate health and socioeconomic disadvantages. There remains an urgent health-related need to identify sustainable strategies to prevent food insecurity in the Latinx population. Methods: A first-generation pilot investigation was conducted using data derived from a sub-study connected to the Computerized Physical Activity Support for Seniors (COMPASS) Trial, a 12-month cluster-randomized controlled trial among older Latinx adults. The sub-study focused on two nutrition interventions that included 1) the Food Literacy and Nutrition (FLAN) curriculum, and 2) a nutrition information-only control. Research hypotheses aimed to determine whether the FLAN intervention reduced food insecurity and increased daily fruit and vegetable servings. Results: On average, participants (n = 39) were 61.5 years of age (SD = 6.7), mostly female (69%), and reported Spanish as their primary language (69%). The FLAN intervention was associated with decreased odds of food insecurity at 12 months (AOR = 0.71, 95% CI = 0.54, 0.95; p = 0.03) when compared to the nutrition-information only control intervention. Although no between-group differences in daily fruit and vegetable servings were found, there was a significant correlation between changes in daily fruit and vegetable servings from baseline to six months and changes in food insecurity from baseline to 12 months (r = -0.51, p = 0.01). Conclusions: The FLAN intervention, a bilingual and culturally tailored educational curriculum, yielded 12-month improvements in food security among a small sample of older Latinx adults. Evidence from this investigation suggests the potential utility of implementing the FLAN curriculum among individuals who are at an increased risk of food insecurity. Further investigation in a larger sample is merited to determine whether the 12-month decreases in food insecurity that were produced by the FLAN intervention can be replicated. Trial Registration: ClinicalTrials.gov Identifier: NCT02111213
摘要 背景:在美国,粮食不安全是一个持续存在且不断加剧的问题,是一种经济和社会状况,涉及获得充足食物的机会有限或不确定。2022 年,拉美裔美国人的粮食不安全率最高(20.8%),他们在健康和社会经济方面已经面临着不成比例的劣势。拉美裔人口在健康方面仍然迫切需要确定可持续的战略,以防止出现粮食不安全问题。方法:利用与 "计算机化老年人体育活动支持(COMPASS)试验 "相关的一项子研究中的数据进行了第一代试点调查,该试验是一项针对拉美裔老年人的为期 12 个月的分组随机对照试验。该子研究重点关注两项营养干预措施,其中包括:1)食品知识与营养(FLAN)课程;2)仅提供营养信息的对照。研究假设旨在确定 FLAN 干预措施是否能减少食物不安全状况并增加每日水果和蔬菜的摄入量。研究结果平均而言,参与者(n = 39)的年龄为 61.5 岁(SD = 6.7),大多数为女性(69%),报告的主要语言为西班牙语(69%)。与仅提供营养信息的对照干预措施相比,FLAN干预措施降低了12个月时的粮食不安全几率(AOR = 0.71,95% CI = 0.54,0.95;P = 0.03)。虽然在每日水果和蔬菜食用量方面没有发现组间差异,但从基线到 6 个月期间每日水果和蔬菜食用量的变化与从基线到 12 个月期间粮食不安全状况的变化之间存在显著相关性(r = -0.51,p = 0.01)。结论FLAN 干预措施是一种双语和文化定制教育课程,在 12 个月内改善了小样本拉丁裔老年人的食品安全状况。这项调查的证据表明,在粮食不安全风险较高的人群中实施 FLAN 课程具有潜在的实用性。有必要在更大的样本中开展进一步调查,以确定 FLAN 干预措施在 12 个月内降低的粮食不安全程度是否可以复制。试验注册:ClinicalTrials.gov Identifier:NCT02111213
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引用次数: 0
Beyond the Granuloma: New Insights into Cardiac Sarcoidosis Using Spatial Proteomics 超越肉芽肿:利用空间蛋白质组学揭示心脏肉样瘤病的新奥秘
Pub Date : 2024-05-07 DOI: 10.21203/rs.3.rs-4289663/v1
E. Peyster, David Smith, Therese Bittermann, Paco Bravo, Kenneth Margulies
Abstract Cardiac sarcoidosis is poorly understood, challenging to diagnose, and portends a poor prognosis. A lack of animal models necessitates the use of residual human samples to study sarcoidosis, which in turn necessitates the use of analytical tools compatible with archival, fixed tissue. We employed high-plex spatial protein analysis within a large cohort of archival human cardiac sarcoidosis and control tissue samples, studying the immunologic, fibrotic, and metabolic landscape of sarcoidosis at different stages of disease, in different cardiac tissue compartments, and in tissue regions with and without overt inflammation. Utilizing a small set of differentially expressed protein biomarkers, we also report the development of a predictive model capable of accurately discriminating between control cardiac tissue and sarcoidosis tissue, even when no histologic evidence of sarcoidosis is present. This finding has major translational implications, with the potential to markedly improve the diagnostic yield of clinical biopsies obtained from suspected sarcoidosis patients.
摘要 心脏肉样瘤病鲜为人知,诊断困难,预后不良。由于缺乏动物模型,因此必须使用残留的人体样本来研究肉样瘤病,这反过来又需要使用与档案固定组织兼容的分析工具。我们在一大批存档的人类心脏肉样瘤病和对照组织样本中采用了高倍空间蛋白质分析,研究了肉样瘤病在不同疾病阶段、不同心脏组织分区以及有明显炎症和无明显炎症组织区域的免疫、纤维化和代谢情况。我们还报告了利用少量差异表达的蛋白质生物标记物开发出的预测模型,该模型能够准确区分对照心脏组织和肉样瘤病组织,即使在没有肉样瘤病组织学证据的情况下也是如此。这一发现具有重大的转化意义,有可能显著提高疑似肉样瘤病患者临床活检的诊断率。
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引用次数: 0
In Vitro Evaluation of the Virulence Attributes of Oropharyngeal Candida Species Isolated from People Living with Human Immunodeficiency Virus with Oropharyngeal Candidiasis on Antiretroviral Therapy 体外评估从接受抗逆转录病毒疗法的口咽念珠菌病人类免疫缺陷病毒感染者中分离出的口咽念珠菌的毒性属性
Pub Date : 2024-05-07 DOI: 10.21203/rs.3.rs-4371952/v1
Benson Musinguzi, Andrew Akampurira, Hope Derick, Alex Mwesigwa, Edson Mwebesa, Vicent Mwesigye, Immaculate Kabajulizi, Tahalu Sekulima, Francis Ocheng, Herbert Itabangi, Gerald Mboowa, O. J. Sande, B. Achan
Abstract Background Oropharyngeal Candida species are part commensal microflora in the the oral cavity of health individuals. Commensal Candida species can become opportunist and transition to pathogenic causes of oropharyngeal candidiasis (OPC) in individuals with impaired immunity through ecological cues and expression of virulence factors. Limited studies have evaluated virulence attributes of oropharyngeal Candida species among people living with human immunodeficiency virus (PLHIV) with OPC on antiretroviral therapy (ART) in Uganda. Objective Evaluation of the Virulence Attributes of Oropharyngeal Candida Species Isolated from People Living with Human Immunodeficiency Virus with Oropharyngeal Candidiasis on Antiretroviral Therapy Methods Thirty-five (35) Candida isolates from PLHIV with OPC on ART were retrieved from sample repository and evaluated for phospholipase activity using the egg yolk agar method, proteinase activity using the bovine serum albumin agar method, hemolysin activity using the blood agar plate method, esterase activity using the Tween 80 opacity test medium method, coagulase activity using the classical tube method and biofilm formation using the microtiter plate assay method in vitro . Results Phospholipase and proteinase activities were detected in 33/35 (94.3%) and 31/35 (88.6%) of the strains, respectively. Up to 25/35 (71.4%) of the strains exhibited biofilm formation while esterase activity was demonstrated in 23/35 (65.7%) of the strains. Fewer isolates 21/35 (60%) of the strains produced hemolysin and coagulase production was the least virulence activity detected in 18/35 (51.4%). Conclusion Phospholipase and proteinase activities were the strongest virulence attributes of oropharyngeal Candida species.
摘要 背景 口咽念珠菌是健康人口腔中的部分共生微生物。共生念珠菌可通过生态线索和毒力因子的表达成为机会致病菌,并在免疫力受损的个体中转变为口咽念珠菌病(OPC)的致病原因。对乌干达接受抗逆转录病毒疗法(ART)的口咽念珠菌感染者的毒力属性进行评估的研究非常有限。目标 评估从接受抗逆转录病毒疗法的口咽念珠菌感染者中分离出的口咽念珠菌菌种的毒性属性 方法 从样本库中提取 35 株从接受抗逆转录病毒疗法的口咽念珠菌感染者中分离出的念珠菌,并采用蛋黄琼脂法评估其磷脂酶活性、采用牛血清白蛋白琼脂法评估磷脂酶活性,采用血液琼脂平板法评估溶血素活性,采用吐温 80 不透明试验培养基法评估酯酶活性,采用经典试管法评估凝固酶活性,采用微孔板检测法评估生物膜形成。结果 在 33/35 株(94.3%)和 31/35 株(88.6%)菌株中分别检测到磷脂酶和蛋白酶活性。多达 25/35 (71.4%)的菌株表现出生物膜形成,而 23/35 (65.7%)的菌株表现出酯酶活性。产生溶血素的分离株较少,为 21/35 株(60%),而产生凝固酶是 18/35 株(51.4%)中检测到的最低毒力活性。结论 磷脂酶和蛋白酶活性是口咽念珠菌的最强毒力属性。
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引用次数: 0
Impact of a multi-level, multi-component intervention to improve elementary school physical education on student cardiorespiratory fitness: an application of the parametric g-formula 改善小学体育教育的多层次、多成分干预措施对学生心肺功能的影响:参数 G 公式的应用
Pub Date : 2024-05-07 DOI: 10.21203/rs.3.rs-4331769/v1
Hannah R. Thompson, Kristine A. Madsen, Caroline Nguyen, Thomas L. McKenzie, Sally Picciotto
Abstract Background: School physical education is an important population-level health intervention for improving youth fitness. The purpose of this study is to determine the causal impact of New York City’s PE Works program on student cardiorespiratory fitness. Methods: This longitudinal study (2014-2019) includes 581 elementary schools (n=315,999 4 th /5 th -grade students; 84% non-white; 74% who qualify for free or reduced-price meals). We apply the parametric g-formula to address schools’ time-varying exposure to intervention components and time-varying confounding. Results: After four years of staggered PE Works implementation, 49.7% of students per school (95% CI: 42.6%, 54.2%) met age/sex-specific cardiorespiratory fitness standards. Had PE Works not been implemented, we estimate 45.7% (95% CI: 36.9%, 52.1%) would have met fitness standards. Had PE Works been fully implemented in all schools from the program’s inception, we estimate 57.4% (95% CI: 49.1%, 63.3%) would have met fitness standards. Adding a PE teacher, alone, had the largest impact (6.4% (95% CI: 1.0, 12.0) increase). Conclusion: PE Works, which included providing PE teachers, training for classroom teachers, and administrative/teacher support for PE, positively impacted student cardiorespiratory health. Mandating and funding multilevel, multicomponent PE programs is an important public health intervention to increase children’s cardiorespiratory fitness.
摘要 背景:学校体育是提高青少年体质的一项重要的全民健康干预措施。本研究旨在确定纽约市体育工程计划对学生心肺功能的因果影响。研究方法:这项纵向研究(2014-2019 年)包括 581 所小学(4/5 年级学生人数为 315999 人;84% 为非白人;74% 有资格享受免费或减价膳食)。我们采用参数 g 公式来处理学校对干预内容的时变暴露和时变混杂。结果:在交错实施体育工程四年后,每所学校有 49.7% 的学生(95% CI:42.6%, 54.2%)达到了特定年龄/性别的心肺功能标准。如果没有实施体育工程,我们估计会有45.7%(95% CI:36.9%,52.1%)的学生达到体适能标准。如果体育工程从一开始就在所有学校全面实施,我们估计会有57.4%(95% CI:49.1%,63.3%)的学生达到体适能标准。增加一名体育教师的影响最大(增加 6.4% (95% CI: 1.0, 12.0))。结论:体育工程包括提供体育教师、培训任课教师以及行政/教师对体育的支持,对学生的心肺健康产生了积极影响。规定并资助多层次、多成分的体育计划是提高儿童心肺功能的重要公共卫生干预措施。
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引用次数: 0
Phenotypical divergence between self-reported and clinically ascertained autism 自我报告与临床确诊的自闭症之间的表型差异
Pub Date : 2024-05-07 DOI: 10.21203/rs.3.rs-4314472/v1
Xiaosi Gu, Sarah Banker, Mathew Schafer, Miles Harrington, Soojung Na, Sarah Barkley, Jadyn Trayvick, Arabella Peters, Abigaël Thinakaran, Jennifer Foss-Feig, Daniela Schiller
Abstract While allowing for rapid recruitment of large samples, online psychiatric and neurodevelopmental research relies heavily on participants’ self-report of neuropsychiatric symptoms, foregoing the rigorous clinical characterization of laboratory settings. Autism spectrum disorder (ASD) research is one example where the clinical validity of such an approach remains elusive. Here, we compared participants characterized online via self-reports against in-person participants evaluated by clinicians. Despite having comparable self-reported autism symptoms, the online high-trait group reported significantly more social anxiety and avoidant behavior than in-person ASD subjects. Within the in-person sample, there was no relationship between self-rated and clinician-rated autism symptoms, suggesting these approaches may capture different aspects of ASD. The online high-trait and in-person ASD participants also differed in their behavior in well-validated social decision-making tasks: the in-person group perceived having less social control and acted less affiliative towards virtual characters. Our study aimed to draw comparisons at three levels: methodological platform (online versus in-person), symptom measurement (self- versus clinician-report), and social behavior. We identified a lack of agreement between self- and clinician-rated measures of symptoms and divergent social tendencies in groups ascertained by each method, highlighting the need for differentiation between in-person versus online samples in autism research.
摘要 在线精神病学和神经发育研究虽然可以快速招募大量样本,但在很大程度上依赖于参与者对神经精神症状的自我报告,放弃了实验室环境中严格的临床特征描述。自闭症谱系障碍(ASD)研究就是这种方法的临床有效性仍然难以确定的一个例子。在这里,我们比较了通过自我报告进行在线描述的参与者和由临床医生进行评估的亲身参与者。尽管自我报告的自闭症症状相似,但在线高特质组报告的社交焦虑和回避行为明显多于面对面的 ASD 受试者。在面对面样本中,自评自闭症症状与临床医生评定的自闭症症状之间没有关系,这表明这些方法可能捕捉到了自闭症的不同方面。在线高特质和亲临现场的 ASD 参与者在经过充分验证的社会决策任务中的行为也有所不同:亲临现场的参与者认为自己的社会控制能力较弱,对虚拟人物的附属性较低。我们的研究旨在从三个层面进行比较:方法平台(在线与面对面)、症状测量(自我报告与临床医生报告)以及社会行为。我们发现,在每种方法确定的群体中,自我和临床医生评定的症状测量结果和不同的社交倾向之间缺乏一致性,这凸显了在自闭症研究中区分面对面样本和在线样本的必要性。
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引用次数: 0
Pediatric Surgery Collaboration in Uganda, the Benefits of Long Term Partnerships at Regional Referral Hospitals 乌干达小儿外科合作,地区转诊医院长期合作的益处
Pub Date : 2024-05-07 DOI: 10.21203/rs.3.rs-4332253/v1
Gregory Klazura, P. Kayima, Martin Situma, Edwin Musinguzi, Robert Mugarura, James Nyonyintono, Ava Yap, James Cope, Richard Akello, Emmanuel Kiwanuka, Moses Odonkara, Chelsea Okellowange, Jennifer Adongpiny, Daniels Lakwanyero, Patricia Atim, Aber Patience Cadrine, Joshua Olara, Amulya Boppana, Ruth Laverde, Sergio d'Agostino, Bruno Cigliano, D. Ozgediz, Thomas Sims, P. Kisa
Abstract Background: In 2022 there were only seven pediatric surgeons in Uganda, but approximately 170 are needed. Consequently, Ugandan general surgeons treat most pediatric surgical problems at regional hospitals. Accordingly, stakeholders created the Pediatric Emergency Surgery Course, which teaches rural providers identification, resuscitation, treatment and referral of pediatric surgical conditions. In order to improve course offerings and better understand pediatric surgery needs we collected admission and operative logbook data from four participating sites. One participating site, Lacor Hospital, rarely referred patients and had a much higher operative volume. Therefore, we sought to understand the causes of this difference and the resulting economic impact. Methods: Over a four-year period, data was collected from logbooks at four different regional referral hospitals in Uganda. Patients < 18 years old with a surgical diagnosis were included. Patient LOS, referral volume, age, and case type were compared between sites and DALYs were calculated and converted into monetary benefit. Results: Over four sites, 8,615 admissions, and 5,457 cases were included. Lacor patients were younger, had a longer length of stay, and were referred less. Additionally, Lacor’s long-term partnerships with a high-income country institution, a missionary organization, and visiting Ugandan and international pediatric surgeons were unique. In 2018, the pediatric surgery case volume was: Lacor (967); Fort Portal (477); Kiwoko (393); and Kabale (153), resulting in a substantial difference in long-term monetary health benefit. Conclusion: Long-term international partnerships may advance investments in surgical infrastructure, workforce, and education in low- and middle-income countries. This collaborative model allows stakeholders to make a greater impact than any single institution could make alone.
摘要 背景:2022 年,乌干达仅有 7 名小儿外科医生,但需要约 170 名。因此,乌干达普通外科医生在地区医院治疗大多数小儿外科问题。因此,相关人员开设了小儿急诊外科课程,教授农村医疗人员识别、抢救、治疗和转诊小儿外科疾病。为了改进课程设置并更好地了解儿科手术需求,我们从四个参与地点收集了入院和手术日志数据。其中一个参与点 Lacor 医院很少转诊病人,手术量却高得多。因此,我们试图了解造成这种差异的原因以及由此产生的经济影响。研究方法在四年时间里,我们从乌干达四家不同地区转诊医院的日志中收集了数据。其中包括年龄小于 18 岁的手术诊断患者。比较了不同医院的患者住院时间、转诊量、年龄和病例类型,计算了残疾调整生命年,并将其转换为经济效益。结果:四家医院共收治 8,615 人,5,457 个病例。Lacor 的患者更年轻,住院时间更长,转诊次数更少。此外,Lacor 与高收入国家机构、传教组织以及来访的乌干达和国际儿科外科医生的长期合作关系也是独一无二的。2018 年,小儿外科手术病例量分别为Lacor(967 例);Fort Portal(477 例);Kiwoko(393 例);Kabale(153 例),从而在长期货币健康效益方面产生了巨大差异。结论长期的国际合作关系可以推动中低收入国家在外科基础设施、劳动力和教育方面的投资。这种合作模式可使利益相关方产生比任何单一机构单独行动更大的影响。
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引用次数: 0
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