medRxiv : the preprint server for health sciences最新文献

Introduction: Waterpipe tobacco smoking (WTS), also known as hookah, shisha, or narghile, is particularly popular among young people in the United States (US). WTS poses serious health risks similar to those of cigarette smoking.

Methods: Using the Twitter/X streaming API (Application Programming Interface), we collected 4,853,562 tweets between March 9, 2021, and March 14, 2023, using waterpipe-related keywords, such as "hookah" and "waterpipe". After geographical filtering to identify tweets from the US and keyword filtering for the promotional content, we identified 23,803 promotional waterpipe-related tweets. We examined trends in the posting time of these promotional waterpipe-related tweets and identified prevalent topics from these tweets using the BERTopic (Bidirectional Encoder Representations from Transformers) modeling.

Results: The number of promotional waterpipe-related tweets showed an overall decreasing trend during the study period. The posting of promotional waterpipe-related tweets was more active later in the day. Major topics in the promotional tweets included "Promotion from hookah lounges and online hookah business" (63.97%, 15,227/23,803), "promoting hookah parties and events" (32.26%, 7,679/23,803), and "promoting engineered and durable hookah products" (3.77%, 897/23,803). Twitter/X accounts posting waterpipe-related promotional content have substantial variations in the number of relevant tweets (mean = 2.28, SD = 12.22) and followers (mean = 5,937, SD = 76,770).

Conclusions: This study demonstrates a significant social media activity in promoting waterpipe tobacco smoking. Our findings underscore the urgent need to regulate the promotional content of WTS on social media and promote public health education messages on social media to counteract the promotion of WTS.

Atherosclerotic cardiovascular disease, the leading cause of global mortality, is driven by lipid accumulation and plaque formation within arterial walls. Carotid plaques, detectable via ultrasound, are a well-established marker of subclinical atherosclerosis. In this study, we trained a deep learning model to detect plaques in 177,757 carotid ultrasound images from 19,499 UK Biobank (UKB) participants (aged 47-83 years) to assess the prevalence, risk factors, prognostic significance, and genetic architecture of carotid atherosclerosis in a large population-based cohort. The model demonstrated high performance metrics with accuracy, sensitivity, specificity, and positive predictive value of 89.3%, 89.5%, 89.2%, and 82.9%, respectively, identifying carotid plaques in 45% of the population. Plaque presence and count were significantly associated with future cardiovascular events over a median follow-up period of up to 7 years, leading to improved risk reclassification beyond established clinical prediction models. A genome-wide association study (GWAS) meta-analysis of carotid plaques (29,790 cases, 36,847 controls) uncovered two novel genomic loci (p < 5×10^-8) with downstream analyses implicating lipoprotein(a) and interleukin-6 signaling, both targets of investigational drugs in advanced clinical development. Observational and Mendelian randomization analyses showed associations between smoking, low-density-lipoprotein (LDL) cholesterol, and high blood pressure and the odds of carotid plaque presence. Our study underscores the potential of carotid plaque assessment for improving cardiovascular risk prediction, provides novel insights into the genetic basis of subclinical atherosclerosis, and offers a valuable resource for advancing atherosclerosis research at the population scale.

Background: Delayed and missed diagnosis are a persistent barrier to tuberculosis control, partly driven by limitations associated with sputum collection and an unmet need for decentralized testing. Household contact investigation with point-of-care testing of non-invasive specimens like tongue swabs are hitherto undescribed and may be a cost-effective solution to enable community-based active case finding.

Methods: In-home, molecular point-of-care testing was conducted using sputum and tongue specimens collected from all household contacts of confirmed tuberculosis cases. A health economic assessment was executed to estimate and compare the cost and cost-effectiveness of different in-home, point-of-care testing strategies. Incremental cost effectiveness ratios of strategies utilizing different combination testing algorithms using sputum and/or tongue swab specimens were compared.

Findings: The total implementation cost of delivering the standard of care for a 2-year period was $84 962. Strategies integrating in-home point-of-care testing ranged between $87 844 - $93 969. The cost-per-test for in-home, POC testing of sputum was the highest at $20·08 per test. Two strategies, Point-of-Care Sputum Testing and Point-of-Care Combined Sputum and Individual Tongue Swab Testing were the most cost-effective with ICERs of $543·74 and $547·29 respectively, both below a $2,760 willingness-to-pay threshold.

Interpretation: An in-home, point-of-care molecular testing strategy utilizing combination testing of tongue swabs and sputum specimens would incur an additional 10.6% program cost, compared to SOC, over a 2-year period. The increased sample yield from tongue swabs combined with immediate result notification following, in-home POC testing would increase the number of new TB cases detected and linked to care by more than 800%.

Objective: Pediatric Veno-Arterial Extra Corporeal Membrane Oxygenation (VA ECMO) is a life saving technology associated with high mortality. A successful VA ECMO course requires attention to multiple aspects of patient care, including ECMO and patient parameters. Early, potentially modifiable, risk factors associated with patient mortality should be analyzed and adjusted for when assessing VA ECMO risk profiles.

Method: Retrospective single center experience of pediatric patients requiring VA ECMO from January 2021 to October 2023. Laboratory and ECMO flow parameters were extracted from the patients record and analyzed. Risk factors were analyzed using a Cox proportion hazard regression.

Main results: There were 45 patients studied. Overall survival was 51%. Upon uncorrected analysis there were no significant differences between the patients who survived and those who died. Utilizing a Cox proportion hazard regression, platelet count, fibrinogen level and creatine level were significant risk factors within the first twenty-four hours of a patient's ECMO course.

Significance: Although we did not find a significant difference among ECMO flow parameters in this study, this work highlights that granular ECMO flow data can be incorporated to risk analysis profiles and potential modeling in pediatric VA ECMO. This study demonstrated, that when controlling for ECMO flow parameters, kidney dysfunction and clotting regulation remain key risk factors for pediatric VA ECMO mortality.

Estimation of multiple chronic condition (MCC) prevalence throughout adulthood provides a critical reflection of MCC burden. We analyzed electronic health record codes for 58 conditions to estimate MCC prevalence for All of Us (AoU) Research Program adult participants (N=242,828). Approximately 76% of AoU participants were diagnosed with MCCs, with over 40% having 6 or more conditions and prevalence increasing with age; the most frequently occurring MCC combinations varied by age category (i.e., mental health conditions in early adulthood and physical health conditions in middle adulthood through advanced old age). We report notable prevalence of MCC throughout adulthood and variability in MCC condition combinations by age category in AoU participants. These findings highlight the need for targeted, innovative care modalities and population health initiatives to address MCC burden throughout adulthood.

Background: The complete blood count (CBC) is one of the most commonly performed laboratory studies. Although studies have found associations between the CBC and cardiovascular disease (CVD), there is limited contemporary information regarding the relationship between the CBC and traditional risk factors and their joint association with CVD endpoints.

Objective: We sought to define the relationships between the CBC and traditional CVD risk factors and their joint association with CVD endpoints in diverse adult populations.

Methods: We first examined the relationships between the CBC variables (directly and their principal components), traditional CVD risk factors, and mortality in NHANES (n=7843). Next, we validated and extended these findings to more refined CVD endpoints in five additional cohorts (n=15,527).

Results: We first examined the variance accounted for by common laboratory studies (lipid panel, HbA1c, hs-CRP, and basic metabolic panel) by traditional risk factors in NHANES. With the exception of hemoglobin (Hb)-related components, we found that traditional risk factors accounted for less than 20% of the variance in CBC values, similar to that of lipid parameters. Additionally, in the clinically adjusted model, the CBC was more strongly associated with all-cause mortality than the lipid panel or CRP (p<0.0001). Next, we validated and extended these findings across five additional longitudinal cohorts with a mean follow-up of 16 years to evaluate the association of individual CBC parameters and their principal components with refined CVD endpoints. In the fully adjusted meta-analyses across the five cohorts, several CBC components including the white blood cell (WBC) count, neutrophil (PMN) count, hemoglobin (Hb) level, and an integrated immune cell score, were associated with individual CVD endpoints and a composite CV endpoint (MACE3: incident stroke, MI, and revascularization) with standardized hazard ratios of 1.13 (p=0.002), 1.15 (p=0.0006), 0.82 (p<0.0001), and 2.16 (p<0.0001) respectively.

Conclusion: This study represents the first systematic examination of the relationship between CBC features and established risk factors, as well as numerous CVD endpoints, in a diverse cohort of 23,370 adults. The findings of this study underscore the potential utility of integrating CBC features into CVD risk assessment and suggest important mechanistic insights into the association between individual CBC components and the genesis of CVD.

While substantial progress has been made in mapping the connectivity of cortical networks responsible for conscious awareness, neuroimaging analysis of subcortical arousal networks that modulate arousal (i.e., wakefulness) has been limited by a lack of a robust segmentation procedures for brainstem arousal nuclei. Automated segmentation of brainstem arousal nuclei is an essential step toward elucidating the physiology of arousal in human consciousness and the pathophysiology of disorders of consciousness. We created a probabilistic atlas of brainstem arousal nuclei built on diffusion MRI scans of five ex vivo human brain specimens scanned at 750 μm isotropic resolution. Labels of arousal nuclei used to generate the probabilistic atlas were manually annotated with reference to nucleus-specific immunostaining in two of the five brain specimens. We then developed a Bayesian segmentation algorithm that utilizes the probabilistic atlas as a generative model and automatically identifies brainstem arousal nuclei in a resolution- and contrast-agnostic manner. The segmentation method displayed high accuracy in both healthy and lesioned in vivo T1 MRI scans and high test-retest reliability across both T1 and T2 MRI contrasts. Finally, we show that the segmentation algorithm can detect volumetric changes and differences in magnetic susceptibility within brainstem arousal nuclei in Alzheimer's disease and traumatic coma, respectively. We release the probabilistic atlas and Bayesian segmentation tool in FreeSurfer to advance the study of human consciousness and its disorders.

We compared the performance of two multiplex platforms, Luminex xTAG Gastrointestinal Pathogen PanelⓇ and TaqMan Array Card, against a panel of 14 enteric pathogen targets in a community-based birth cohort in Ecuador. We found high levels of agreement and similar prevalence estimates across most pathogens.

Disorders of consciousness (DoC) are states of impaired arousal or awareness. Deep brain stimulation (DBS) is a potential treatment, but outcomes vary, possibly due to differences in patient characteristics, electrode placement, or stimulation of specific brain networks. We studied 40 patients with DoC who underwent DBS targeting the thalamic centromedian-parafascicular complex. Better-preserved gray matter, especially in the striatum, correlated with consciousness improvement. Stimulation was most effective when electric fields extended into parafascicular and subparafascicular nuclei-ventral to the centromedian nucleus, near the midbrain-and when it engaged projection pathways of the ascending arousal network, including the hypothalamus, brainstem, and frontal lobe. Moreover, effective DBS sites were connected to networks similar to those underlying impaired consciousness due to generalized absence seizures and acquired lesions. These findings support the therapeutic potential of DBS for DoC, emphasizing the importance of precise targeting and revealing a broader link between effective DoC treatment and mechanisms underlying other conscciousness-impairing conditions.