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Ligilactobacillus salivarius V4II-90 eradicates Group B Streptococcus colonisation during pregnancy: a randomised, double-blind, placebo-controlled trial.
No full text20.500.12530/87913Group B Streptococcus (GBS) is the leading cause of bacterial neonatal sepsis. This study aimed to confirm the effect of Ligilactobacillus salivarius V4II-90 on GBS colonisation during pregnancy. A randomised, multicentre, double-blind, placebo-controlled, parallel-group study was conducted in seven hospitals in Madrid, Spain. The sample was broken down into two groups with 20 participants each (n = 40) in order to show reduced GBS colonisation frequency in the probiotic versus the placebo group. Pregnant participants positive for vaginal-rectal colonisation before or during the 13th week of gestation were randomly assigned to either the placebo or the probiotic group. The probiotic, L. salivarius V4II-90 at 1 × 109 cfu/day was administered for 12 weeks, starting at week 21-23 of gestation. The primary outcome was the percentage of participants with vaginal and/or rectal GBS colonisation at the end of the intervention period (35 weeks of gestation). Secondary outcomes were changes in the microbial composition of vaginal and rectal exudates; premature delivery; premature rupture of membranes; intrapartum antibiotics; new-borns with early or late-onset GBS sepsis; adverse events (AEs); and GBS test results performed at the hospital at week 35 of gestation. Of the 481 participants included, 44 were vaginal-rectal colonised with GBS and randomised. 43 completed the study (20 in the probiotic group and 23 in the placebo group). After intervention, GBS was eradicated in six participants (27%) from the placebo group and in twelve participants (63%) from the probiotic group ( P = 0.030). None of the 185 AEs reported were identified as possibly, probably, or definitely related to the investigational product. In conclusion, oral administration of L. salivarius V4II-90 is a safe and successful strategy to significantly decrease the rates of GBS colonisation at the end of pregnancy and, therefore, to reduce the exposure of subjects and their infants to intrapartum antibiotic prophylaxis. Trial registered at ClinicalTrials.gov: number NCT03669094
Suicidal Behaviour and Stressful Life Events: The Mediating Role of the Impulsivity-Aggression-Hostility Triad Through Psychological Autopsy.
No full text20.500.12530/87858Stressful life events (SLEs), impulsivity, aggression, and hostility are known risk factors for suicide. The existence of an "I-A-H Triad" (composed of impulsiveness, aggressiveness and hostility) is proposed as a mediating factor between SLEs and suicide. Data on 399 deceased people (274 from suicide, 125 from other causes) were collected through psychological autopsy. The Paul Ramsey Life Experience Scale (to collect SLE history), the Barrat Impulsivity Scale (BIS-11) and the Buss-Durkee Hostility Inventory (BDHI) were applied, using versions adapted for psychological autopsy. Comparative analysis of the two groups showed significant differences in the variables of interest (SLE: t = 7.280; BDHI: = 4.201; BIS-11: t = 3.812; I-A-H Triad: t = 4.84). Mediation analysis confirmed the role of the I-A-H Triad in mediation of the presence of SLEs and the type of death. High levels of impulsivity, aggression, and hostility increase the risk of suicide when a person is faced with SLEs
The art of selecting the ECG input in neural networks to classify heart diseases: a dual focus on maximizing information and reducing redundancy.
No full text20.500.12530/87857Accurate diagnosis of cardiovascular diseases often relies on the electrocardiogram (ECG). Since the cardiac vector is located within a three-dimensional space and the standard ECG comprises 12 projections or leads derived from it, redundant information is inherently present. This study aims to quantify this redundancy and its impact on classification tasks using Convolutional Neural Networks (CNNs) in cardiovascular diseases. We employed signal theory and mutual information to introduce a novel redundancy metric and explored techniques for redundancy augmentation and reduction. This involved lead selection and transformation to evaluate the effects on neural network performance. Our findings indicate that optimizing input configurations through redundancy reduction techniques can enhance the performance of deep learning models in cardiovascular diagnostics, provided that the information is preserved and minimally distorted. For the first time, this research has quantified the redundancy present in the input by validating various redundancy reduction techniques using a CNN. This discovery paves the way for advancing biomedical signal processing research, simplifying model complexity, and enhancing diagnostic performance in cardiovascular medicine within reduced lead systems, such as Holter monitors or wearables
Predictive value of sarcopenia components for all-cause mortality: findings from population-based cohorts.
No full text20.500.12530/87854Low grip strength and gait speed are associated with mortality. However, investigation of the additional mortality risk explained by these measures, over and above other factors, is limited. We examined whether grip strength and gait speed improve discriminative capacity for mortality over and above more readily obtainable clinical risk factors. Participants from the Health, Aging and Body Composition Study, Osteoporotic Fractures in Men Study, and the Hertfordshire Cohort Study were analysed. Appendicular lean mass (ALM) was ascertained using DXA; muscle strength by grip dynamometry; and usual gait speed over 2.4-6 m. Verified deaths were recorded. Associations between sarcopenia components and mortality were examined using Cox regression with cohort as a random effect; discriminative capacity was assessed using Harrell's Concordance Index (C-index). Mean (SD) age of participants (n = 8362) was 73.8(5.1) years; 5231(62.6%) died during a median follow-up time of 13.3 years. Grip strength (hazard ratio (95% CI) per SD decrease: 1.14 (1.10,1.19)) and gait speed (1.21 (1.17,1.26)), but not ALM index (1.01 (0.95,1.06)), were associated with mortality in mutually-adjusted models after accounting for age, sex, BMI, smoking status, alcohol consumption, physical activity, ethnicity, education, history of fractures and falls, femoral neck bone mineral density (BMD), self-rated health, cognitive function and number of comorbidities. However, a model containing only age and sex as exposures gave a C-index (95% CI) of 0.65(0.64,0.66), which only increased to 0.67(0.67,0.68) after inclusion of grip strength and gait speed. Grip strength and gait speed may generate only modest adjunctive risk information for mortality compared with other more readily obtainable risk factors
Gender-specific capacity of insulin resistance proxies to predict functional decline in older adults.
No full text20.500.12530/87854Insulin resistance determined by Homeostasis Model of Insulin Resistance (HOMA-IR) has been associated with functional decline in non-diabetic older subjects. However, insulin is not routinely assessed. The study evaluated the predictive value of non-insulin-dependent IR surrogates on functional decline in non-diabetic older men and women. Prospective cohort study over 5 years. The study included 615 older participants from the Toledo Study of Healthy Aging. Frailty was assessed by the Frailty Trait Scale-5 (FTS-5) at baseline and after 5 years follow-up. 193 subjects experienced functional decline (2.5-point reduction in the FTS-5 score). Multivariate regression models analysed the effect of five described IR surrogates on functional decline considering potential confounders. Among evaluated IR proxies, triglyceride glucose-body mass index (TyG-BMI) and HOMA-IR were significantly associated with an increased risk of functional decline (odd ratio (95% confidence interval) TyG-BMI: 1.16 (1.05, 1.28), p = 0.0035 and HOMA-IR: 1.59 (1.15, 2.21), p = 0.0056) among all participants. When stratified by gender, HOMA-IR was related to functional decline in men [2.02 (1.13, 3.59), p = 0.0173] and TyG-BMI in women [1.19 (1.05, 1.35), p = 0.0057]. Only TyG-BMI index mimics the predictive capacity of insulin-based IR marker. The predictive ability of IR indexes is gender-specific, being TyG-BMI the only index able to predict functional decline in women and HOMA-IR in men
Estimation of the Cyclopean Eye From Binocular Smooth Pursuit Tests
No full text20.500.12530/87858In binocular vision, the visual system combines images in the retina to generate a single perception, which triggers a sensorimotor process that forces the eyes to point to the same target. Thus, following a moving target, both eyes are expected to move synchronously following identical motor triggers but, in practise, significant differences between eyes are found due to the presence of certain artifacts and effects. Thus, a better indirect characterization of the underlying neurological behavior during eye motion would require new automatic preprocessing methods applied to the eye-tracking sequences for rendering the common and most significant movements of both eyes. To address this need, the present study proposes an automatic method for extracting the common components of the left- and right-eye motions from a set of Smooth Pursuit tests by applying an independent component analysis. To do so, both sequences are decomposed into two independent latent components: the first presumably correlates with the common motor triggering at the brain, while the second collects artifacts introduced during the recording process and small effects due to convergence deficits and eye dominance biases. The evaluations were carried out using data corresponding to 12 different smooth pursuit eye movements tests, which were collected using an infrared high-speed video-based eye-tracking device from 41 parkinsonian patients and 47 controls. The results show that the automatic method can separate the aforementioned components in 99.50% of cases, extracting a latent component correlated with the common motor triggering at the brain, which we hypothesize is characterizing the movements of the cyclopean eye. The estimated component could be used to simplify any other potential automatic analysis
Estudio multicéntrico sobre las características sociales, epidemiológicas y clínicas en las intoxicaciones con finalidad suicida en adolescentes.
No full text20.500.12530/87849To evaluate the social, epidemiological, and clinical characteristics of patients brought to Spanish pediatric emergency departments (EDs) after suicide attempts by poisoning. A secondary objective was to identify risk factors for moderate-severe poisoning. Prospective multicenter cohort study. We included patients under the age of 18 years who were brought to 20 Spanish pediatric EDs after attempting suicide between January 2021 and June 2022. Case histories were reviewed and the patients were interviewed. A Poisoning Severity Score of 2 or more was classified as moderate-severe. A total of 592 episodes were studied; 541 of the patients (91.4%) were girls. The median (P25-P75) age was 14.6 years (13.6-15.7 years). A psychiatric diagnosis had been made in 417 (70.4%), 334 (56.4%) had attempted suicide previously, and 409 (69.1%) had been victims of bullying. Medications were ingested by 584 (98.6%). The most often used were benzodiazepines (used by 222; 37.5%) and paracetamol (by 187; 31.6%). Fifty-three poisonings were classified as moderate-severe. A mental health evaluation was carried out in 585 cases (98.8%). Odds ratios (ORs) indicated that higher risk of moderate-severe poisoning was associated with having an adjustment disorder (OR, 3.2; P25-P75, 1.1-9.0; P = .027), using opioids (OR, 6.4; P25-P75, 1.2-35.4; P = .032), and taking of antidiabetic drugs (OR, 27.6; P25-P75, 1.2-634.9; P = .038). Being a victim of bullying (OR, 0.4; P25-P75, 0.2-0.8; P = .013] and using nonsteroidal anti-inflammatory drugs (OR, 0.3; P25-P75, 0.1-0.8; P = .020) decreased risk. Pediatric ED visits for suicide attempts by poisoning occur mainly in adolescent girls, and a majority have a medical history of a psychiatric diagnosis, prior suicide attempts, or self-harm behaviors. They have also often experienced bullying. Characteristics that distinguish patients with moderate-severe poisoning are the presence of an adjustment disorder and the use of opioids and antidiabetic drugs, which confer risk for greater severity
IBD-PODCAST Spain: A Close Look at Current Daily Clinical Practice in IBD Management.
No full text20.500.12530/87871Crohn's disease (CD) and ulcerative colitis (UC) are inflammatory bowel diseases (IBD) that contributes in part to irreversible bowel damage and long-term complications, reduced quality of life, invalidity, and economic burden. Suboptimal control of IBD is associated with higher healthcare resource utilization (HCRU), impaired quality of life (QoL), and reduced work productivity. The IBD-PODCAST study aimed to assess the proportion of IBD patients with suboptimal control and its associated impact. IBD-PODCAST is a cross-sectional, multicenter study that aimed to characterize the CD and UC population with optimal or suboptimal control according to the STRIDE-II criteria and patient- and physician-reported measures. Here we present the results of the Spanish cohort (n = 396). A total of 104/196 (53.1%) CD and 83/200 (41.5%) UC patients were found to have suboptimal disease control. Long-term treatment targets according to STRIDE-II were applied in 172 (87.8%) CD and 181 (90.5%) UC patients. 125 of 172 (72.7%) CD and 74 of 181 (40.9%) UC patients were currently treated with targeted immunomodulators. Patients with CD and UC and suboptimal disease control showed impaired QoL, higher HCRU and direct costs, and also loss of work productivity compared to those with optimal control. Despite a high rate of targeted immunomodulator therapy, a substantial proportion of IBD patients show suboptimal disease control according to the STRIDE II criteria. Those patients with suboptimal disease control exhibit impaired QoL, less work productivity, and higher HCRU, suggesting that there is considerable need for better treatment approaches in IBD
Asciminib monotherapy in patients with chronic-phase chronic myeloid leukemia with the T315I mutation after ≥1 prior tyrosine kinase inhibitor: 2-year follow-up results.
No full textAsciminib targets the BCR::ABL1 myristoyl pocket, maintaining activity against BCR::ABL1T315I, which is resistant to most approved adenosine triphosphate-competitive tyrosine kinase inhibitors. We report updated phase I results (NCT02081378) assessing safety/tolerability and antileukemic activity of asciminib monotherapy 200 mg twice daily in 48 heavily pretreated patients with T315I-mutated chronic-phase chronic myeloid leukemia (CML-CP; data cutoff: January 6, 2021). With 2 years' median exposure, 56.3% of patients continued receiving asciminib. Overall, 62.2% of evaluable patients achieved BCR::ABL1 ≤1% on the International Scale (IS); 47.6% and 81.3% of ponatinib-pretreated and -naive patients, respectively, achieved BCR::ABL1IS ≤1%. Of 45 evaluable patients, 48.9% achieved a major molecular response (MMR, BCR::ABL1IS ≤0.1%), including 34.6% and 68.4% of ponatinib-pretreated and -naive patients, respectively. MMR was maintained until data cutoff in 19 of 22 patients who achieved it. The most common grade ≥3 adverse events (AEs) included increased lipase level (18.8%) and thrombocytopenia (14.6%). Five (10.4%) patients experienced AEs leading to discontinuation, including 2 who discontinued asciminib and died due to COVID-19; these were the only deaths reported. These results show asciminib's effectiveness, including in almost 50% of ponatinib pretreated patients, and confirm its risk-benefit profile, supporting its use as a treatment option for T315I-mutated CML-CP
Suicidal Behavior and Social Cognition: The Role of Hypomentalizing and Fearlessness About Death.
No full text20.500.12530/87857Suicide attempt (SA) lethality is associated with heightened suicidal desires and social cognition deficits. Fearlessness about death (FAD) and hypomentalizing may play a role in SA and self-harm. Although studies have identified relationships between these constructs, this line of research is still limited. We aimed to explore the mediating role of FAD and mentalizing between suicidal ideation and both SA lethality and self-harm. 1,371 suicide attempters (70.1% women; M = 40 years) from seven Spanish hospitals participated. We used the Fearlessness About Death (ACSS-FAD) subscale, the Reflective Functioning Questionnaire-8 (RFQ-8), and the Columbia Suicide Severity Rating Scale (CSSRS). We conducted serial multiple mediation analyses with suicidal ideation as exposure; FAD and mentalizing as mediators; SA lethality and self-harm as outcomes. Indirect effects were found of suicidal ideation on self-harm ( B = 0.08, CI = 0.03-0.15) and SA lethality mediated by FAD ( B = 0.02, CI = 0.001-0.04); indirect effects of suicidal ideation on self-harm through mentalizing ( B = 0.10, CI = 0.04-0.167), and total indirect effects between suicidal ideation and self-harm through FAD and mentalizing ( B = 0.18, CI = 0.11-0.27). Interventions addressing mentalizing and FAD may help reduce SA lethality and self-harm risk