Ocular effects of exposure to low-humidity environment with contact lens wear: A pilot study.

PURPOSE: To compare the ocular effects of exposure to a low-humidity environment with and without contact lens (CL) wear using various non-invasive tests. METHODS: Fourteen habitual soft CL wearers were exposed to controlled low humidity (5% relative humidity [RH]) in an environmental chamber for 90 min on two separate occasions. First, when wearing their habitual spectacles and then, on a separate visit, when wearing silicone hydrogel CLs that were fitted specifically for this purpose. All participants had adapted to the new CL prior to data collection. Three non-invasive objective measurements were taken at each visit: blinking rate, objective ocular scatter (measured using the objective scatter index) and ocular surface cooling rate (measured using a long-wave infrared thermal camera). At each visit, measurements were taken before the exposure in comfortable environmental conditions (RH: 45%), and after exposure to environmental stress (low humidity, RH: 5%). RESULTS: CL wearers showed increased blinking rate (p < 0.005) and ocular scatter (p = 0.03) but similar cooling rate of the ocular surface (p = 0.08) when compared with spectacle wear in comfortable environmental conditions. The exposure to low humidity increased the blinking rate significantly with both types of corrections (p = 0.01). Interestingly, ocular scatter (p = 0.96) and cooling rate (p = 0.73) were not significantly different before and after exposure to low humidity. There were no significant two-way interactions between correction and exposure in any of the measurements. CONCLUSIONS: CLs significantly increased the blinking rate, which prevented a quick degradation of the tear film integrity as it was refreshed more regularly. It is hypothesised that the increased blinking rate in CL wearers aids in maintaining ocular scatter quality and cooling rate when exposed to a low-humidity environment. These results highlight the importance of blinking in maintaining tear film stability.

Misunderstood and underappreciated: a critical review of mental health advocacy and activism in low- and middle-income countries.

Mental health advocacy and activism have been highlighted as important in the effort towards creating environments for better mental health. However, relevant research in low- and middle-income country settings remains limited and lacks critical exploration. We seek to contribute to filling this gap by exploring driving factors behind mental health advocacy and activism efforts in low- and middle-income country settings. This review uses a critically informed thematic analysis employing conceptual frameworks of productive power to analyse peer-reviewed articles on mental health advocacy or activism over the last 20 years. We suggest that the current body of research is marred by superficial explorations of activism and advocacy, partly due to a lack of cohesion around definitions. Based on our findings, we suggest a conceptual framework to guide deeper explorations of mental health advocacy and activism. This framework identifies 'legitimacy', 'context' and 'timing' as the main dimensions to consider in understanding activism and advocacy efforts. The fact that they remain misunderstood and underappreciated creates missed opportunities for meaningful inclusion of lived experience in policy decisions and limits our understanding of how communities envision and enact change.

Are artificial intelligence chatbots a reliable source of information about contact lenses?

INTRODUCTION: Artificial Intelligence (AI) chatbots are able to explain complex concepts using plain language. The aim of this study was to assess the accuracy of three AI chatbots answering common questions related to contact lens (CL) wear. METHODS: Three open access AI chatbots were compared: Perplexity, Open Assistant and ChatGPT 3.5. Ten general CL questions were asked to all AI chatbots on the same day in two different countries, with the questions asked in Spanish from Spain and in English from the U.K. Two independent optometrists with experience working in each country assessed the accuracy of the answers provided. Also, the AI chatbots' responses were assessed if their outputs showed any bias towards (or against) any eye care professional (ECP). RESULTS: The answers obtained by the same AI chatbots were different in Spain and the U.K. Also, statistically significant differences were found between the AI chatbots for accuracy. In the U.K., ChatGPT 3.5 was the most and Open Assistant least accurate (p < 0.01). In Spain, Perplexity and ChatGPT were statistically more accurate than Open Assistant (p < 0.01). All the AI chatbots presented bias, except ChatGPT 3.5 in Spain. CONCLUSIONS: AI chatbots do not always consider local CL legislation, and their accuracy seems to be dependent on the language used to interact with them. Hence, at this time, although some AI chatbots might be a good source of information for general CL related questions, they cannot replace an ECP.

Advantages of Short-Segment Fusion in the Surgical Management of Thoracolumbar Traumatic Fractures: A Case Series and Review of the Literature.

INTRODUCTION: Spine trauma is a common pathology that frequently requires neurosurgical intervention. Few studies have examined short-segment, 360-degree stabilization of traumatic thoracolumbar fractures. METHODS: A retrospective review was completed of adult and pediatric patients who underwent surgical correction for thoracolumbar fractures between December 2011 and December 2021. RESULTS: Forty patients met the inclusion criteria. The majority of patients presented with an American Spinal Injury Association (ASIA) score of D (n = 11) or E (n = 21). The most common level of injury was L1 (n = 20). The average length of stay was 11.7 days. Postoperatively, two patients had pulmonary emboli or deep venous thrombosis, and two had surgical site infections. Most patients were discharged to home (n = 21) or acute rehab (n = 14). The fusion rate at six months was 97.5%. Neurologically, all patients regained ambulation by >18 months follow-up. For the ASIA scale, most had a score of D (n = 4) or E (n = 32) at six months. The same trend was observed with the Frankel score, where most patients had either D (n = 5) or E (n = 31), improving to only two having a score of D at >18 months. CONCLUSIONS: Corpectomy followed by posterior fusion has a number of biomechanical benefits. This construct permits circumferential decompression, larger surface area for fusion, improved reconstitution of vertebral body height, reduced kyphosis, and an overall shorter segment. This results in fewer levels needing to be fused while enabling the greatest changes of successful fusion.

Daily running enhances molecular and physiological circadian rhythms in skeletal muscle.

OBJECTIVE: Exercise is a critical component of a healthy lifestyle and a key strategy for the prevention and management of metabolic disease. Identifying molecular mechanisms underlying adaptation in response to chronic physical activity is of critical interest in metabolic physiology. Circadian rhythms broadly modulate metabolism, including muscle substrate utilization and exercise capacity. Here, we define the molecular and physiological changes induced across the daily cycle by voluntary low intensity daily exercise. METHODS: Wildtype C57BL6/J male and female mice were housed with or without access to a running wheel for six weeks. Maximum running speed was measured at four different zeitgeber times (ZTs, hours after lights on) using either electrical or manual stimulation to motivate continued running on a motorized treadmill. RNA isolated from plantaris muscles at six ZTs was sequenced to establish the impact of daily activity on genome-wide transcription. Patterns of gene expression were analyzed using Gene Set Enrichment Analysis (GSEA) and Detection of Differential Rhythmicity (DODR). Blood glucose, lactate, and ketones, and muscle and liver glycogen were measured before and after exercise. RESULTS: We demonstrate that the use of mild electrical shocks to motivate running negatively impacts maximum running speed in mice, and describe a manual method to motivate running in rodent exercise studies. Using this method, we show that time of day influences the increase in exercise capacity afforded by six weeks of voluntary wheel running: when maximum running speed is measured at the beginning of the nighttime active period in mice, there is no measurable benefit from a history of daily voluntary running, while maximum increase in performance occurs at the end of the night. We show that daily voluntary exercise dramatically remodels the murine muscle circadian transcriptome. Finally, we describe daily rhythms in carbohydrate metabolism associated with the time-dependent response to moderate daily exercise in mice. CONCLUSIONS: Collectively, these data indicate that chronic nighttime physical activity dramatically remodels daily rhythms of murine muscle gene expression, which in turn support daily fluctuations in exercise performance.

Changes in 25-hydroxyvitamin D levels post-vitamin D supplementation in people of Black and Asian ethnicities and its implications during COVID-19 pandemic: A systematic review.

BACKGROUND: People of Black and Asian ethnicities have a higher infection rate and mortality as a result of COVID-19. It has also been reported that vitamin D deficiency may play a role in this, possibly because of the multi-gene regulatory function of the vitamin D receptor. As a result, increased dietary intake and/or supplementation to attain adequate 25-hydroxyvitamin D (25(OH)D) levels could benefit people in these ethnicities. The present study aimed to review the literature examining the changes in 25(OH)D in different types of vitamin D supplementation from randomised controlled trials in this population. METHODS: This systematic review was conducted using the PRISMA guidelines. Electronic databases were systematically searched using keywords related to vitamin D supplementation in Black and Asian ethnicities. RESULTS: Eight studies were included in the review. All the included studies found that supplementation of vitamin D (D2 and D3 ), regardless of dosage, increased 25(OH)D levels compared to a placebo. All trials in which participants were vitamin D deficient at baseline showed increased 25(OH)D levels to a level considered adequate. Two studies that used food fortification yielded smaller 25(OH)D increases compared to similar studies that used oral supplementation (10.2 vs. 25.5 nmol L-1 , respectively). Furthermore, vitamin D2 supplementation yielded significantly lower 25(OH)D increases than vitamin D3 supplementation. CONCLUSIONS: Oral vitamin D supplementation may be more efficacious in increasing 25(OH)D levels than food fortification of Black and Asian ethnicities, with vitamin D3 supplementation possibly being more efficacious than vitamin D2 . It is recommended that people with darker skin supplement their diet with vitamin D3 through oral tablet modes where possible, with recent literature suggesting a daily intake of 7000-10,000 IU to be potentially protective from unfavourable COVID-19 outcomes. As a result of the paucity of studies, these findings should be treated as exploratory.

The Risk of COVID-19 Related Hospitalsation, Intensive Care Unit Admission and Mortality in People With Underlying Asthma or COPD: A Systematic Review and Meta-Analysis.

Background: Several underlying diseases have been associated with unfavorable COVID-19 related outcomes including asthma and Chronic Obstructive Pulmonary Disease (COPD), however few studies have reported risks that are adjusted for confounding variables. This study aimed to examine the adjusted risk of COVID-19 related hospitalsation, intensive care unit (ICU) admission, and mortality in patients with vs. without asthma or COPD. Methods: A systematic review of major databases was undertaken for studies published between 1/12/2019 and 19/4/2021. Studies reporting the adjusted (for one or more confounder) risks of either hospitalsation, ICU admission, or mortality in asthmatics or COPD patients (control group = no asthma or no COPD) were identified. Risk of bias was determined via the QUIPS tool. A random effect meta-analysis was undertaken. Findings: 37 studies were eligible for analysis, with a total of 1,678,992 participants. The pooled ORs of COVID-19 hospitalsation in subjects with asthma and COPD was 0.91 (95% CI 0.76-1.09) and 1.37 (95% CI 1.29-1.46), respectively. For ICU admission, OR in subjects with asthma and COPD was 0.89 (95% CI 0.74-1.07) and 1.22 (95% CI 1.04-1.42), respectively. For mortality, ORs were 0.88 (95% CI 0.77-1.01) and 1.25 (95% CI 1.08-1.34) for asthma and COPD, respectively. Further, the pooled risk of mortality as measured via Cox regression was 0.93 (95% CI 0.87-1.00) for asthma and 1.30 (95% CI 1.17-1.44) for COPD. All of these findings were of a moderate level of certainty. Interpretation: COPD was significantly associated with COVID-19 related hospital admission, ICU admission, and mortality. Asthma was not associated with negative COVID-19 related health outcomes. Individuals with COPD should take precautions to limit the risk of COVID-19 exposure to negate these potential outcomes. Limitations include differing population types and adjustment for differing cofounding variables. Practitioners should note these findings when dealing with patients with these comorbidities. Review Protocol Registration: https://www.crd.york.ac.uk/prospero/.

Cryptochromes Suppress HIF1α in Muscles.

Muscles preferentially utilize glycolytic or oxidative metabolism depending on the intensity of physical activity. Transcripts required for carbohydrate and lipid metabolism undergo circadian oscillations of expression in muscles, and both exercise capacity and the metabolic response to exercise are influenced by time of day. The circadian repressors CRY1 and CRY2 repress peroxisome proliferator-activated receptor delta (PPARδ), a major driver of oxidative metabolism and exercise endurance. CRY-deficient mice exhibit enhanced PPARδ activation and greater maximum speed when running on a treadmill but no increase in exercise endurance. Here we demonstrate that CRYs limit hypoxia-responsive transcription via repression of HIF1α-BMAL1 heterodimers. Furthermore, CRY2 appeared to be more effective than CRY1 in the reduction of HIF1α protein steady-state levels in primary myotubes and quadriceps in vivo. Finally, CRY-deficient myotubes exhibit metabolic alterations consistent with cryptochrome-dependent suppression of HIF1α, which likely contributes to circadian modulation of muscle metabolism.

Vulnerability to helpless behavior is regulated by the circadian clock component CRYPTOCHROME in the mouse nucleus accumbens.

The nucleus accumbens (NAc), a central component of the midbrain dopamine reward circuit, exhibits disturbed circadian rhythms in the postmortem brains of depressed patients. We hypothesized that normal mood regulation requires proper circadian timing in the NAc, and that mood disorders are associated with dysfunctions of the NAc cellular circadian clock. In mice exhibiting stress-induced depression-like behavior (helplessness), we found altered circadian clock function and high nighttime expression of the core circadian clock component CRYPTOCHROME (CRY) in the NAc. In the NAc of helpless mice, we found that higher expression of CRY is associated with decreased activation of dopamine 1 receptor-expressing medium spiny neurons (D1R-MSNs). Furthermore, D1R-MSN-specific CRY-knockdown in the NAc reduced susceptibility to stress-induced helplessness and increased NAc neuronal activation at night. Finally, we show that CRY inhibits D1R-induced G protein activation, likely by interacting with the Gs protein. Altered circadian rhythms and CRY expression were also observed in human fibroblasts from major depressive disorder patients. Our data reveal a causal role for CRY in regulating the midbrain dopamine reward system, and provide a mechanistic link between the NAc circadian clock and vulnerability to depression.

Sore eyes as the most significant ocular symptom experienced by people with COVID-19: a comparison between pre-COVID-19 and during COVID-19 states.

OBJECTIVE: Conjunctivitis has been reported in people suffering from COVID-19. However, many ocular symptoms are associated with the term 'conjunctivitis' which may be misleading. It is also unknown whether ocular symptoms were different in chronic sufferers of anterior eye diseases, when they were experienced or how long they lasted for compared with other COVID-19 symptoms. METHODS: An online structured questionnaire obtained self-report data from people who had a confirmed diagnosis of COVID-19. Data for the type, frequency and duration of different COVID-19 symptoms were ascertained. Anterior eye symptoms experienced by participants in the pre-COVID-19 state were compared with during the COVID-19 state. RESULTS: Data from 83 participants showed that the most reported COVID-19 symptoms were dry cough (66%), fever (76%), fatigue (90%) and loss of smell/taste (70%). The three most common ocular symptoms experienced by participants were photophobia (18%), sore eyes (16%) and itchy eyes (17%). The frequency of sore eyes was significantly higher (p=0.002) during COVID-19 state (16%) compared with pre-COVID-19 state (5%). There were no differences between males and females (p>0.05). 81% of participants reported to have experienced ocular symptoms within 2 weeks of other COVID-19 symptoms, and 80% reported they lasted for less than 2 weeks. CONCLUSION: The most significant ocular symptom experienced by people suffering from COVID-19 was sore eyes. Other symptoms associated with other types of conjunctivitis, such as mucous discharge and gritty eyes linked to bacterial infection, did not reach significance. The term 'conjunctivitis' is too broad and should be used with caution.

Isolation and Differentiation of Primary Myoblasts from Mouse Skeletal Muscle Explants.

Primary myoblasts are undifferentiated proliferating precursors of skeletal muscle. They can be cultured and studied as muscle precursors or induced to differentiate into later stages of muscle development. The protocol provided here describes a robust method for the isolation and culture of a highly proliferative population of myoblast cells from young adult mouse skeletal muscle explants. These cells are useful for the study of the metabolic properties of skeletal muscle of different mouse models, as well as in other downstream applications such as transfection with exogenous DNA or transduction with viral expression vectors. The level of differentiation and metabolic profile of these cells depends on the length of exposure, and composition of the media used to induce myoblast differentiation. These methods provide a robust system for the study of mouse muscle cell metabolism ex vivo. Importantly, unlike in vivo models, the methods described here provide a cell population that can be expanded and studied with high levels of reproducibility.

Reframing NCDs? An analysis of current debates.

There have been many debates in recent years as to whether the communicable disease versus non-communicable disease (NCD) division is a meaningful one in disease classification. Several critiques have been raised about the framing of NCDs, regarding not only the prominent role that infections play in the aetiology of NCDs, but also the communicability of many social determinants of NCDs and the individualistic, 'lifestyle' framing of NCDs that tends to focus on health behaviours to the neglect of socio-political, environmental, and structural determinants of health. In this paper, we give a historical overview of the usage of the NCD terminology and analyse some of the recent debates regarding the naming and framing of NCDs. We argue that a lack of reflection on the assumptions underlying the naming and framing of NCDs may lead to the collection of insufficient epidemiological data, the development of inappropriate interventions and the provision of inadequate care. Work in social epidemiology, health promotion, medical anthropology, demography, and other fields may provide insights into the ways in which efforts targeting NCDs may be reframed to improve impact and efficacy. In addition, concepts such as multimorbidity and syndemics, frameworks such as ecosocial theory and approaches based in the social sciences may provide a way forward in the conceptualization of disease.

Phosphorylation of CRY1 Serine 71 Alters Voluntary Activity but Not Circadian Rhythms In Vivo.

Circadian clocks allow organisms to anticipate repetitive changes in their environment such as food availability, temperature, and predation. While they most clearly manifest at the behavioral level, driving sleep-wake cycles, for example, they also provide critical temporal regulation at the level of individual tissues. Circadian clocks within organs act to ensure that each tissue is functioning in a coordinated manner to anticipate the needs of the organism as a whole but also allow for adaptation of organs to their local environment. One critical aspect of this environment is energy availability, which is communicated at the cellular level via changes in metabolites such as ATP, calcium, and NADH. AMP-activated protein kinase (AMPK) is both sensitive to fluctuations in secondary metabolites and capable of resetting the circadian clock via destabilization of the core clock components CRY and PER. Phosphorylation of serine 71 of CRY1 by AMPK destabilizes CRY1 by decreasing its interaction with binding partner PER2, thus enabling greater association with the SCF complex substrate adaptor FBXL3. Here, we describe a transgenic mouse harboring germline mutation of CRY1 serine 71 to alanine. Unexpectedly, this mutation does not affect the steady-state level of CRY1 protein in mouse livers or quadriceps. We also did not detect changes in either behavioral or molecular circadian rhythms, but female Cry1S71A mice exhibit decreased voluntary locomotor activity compared with wild-type littermates. Together, these findings suggest that phosphorylation of CRY1 serine 71 is not required for the regulation of circadian rhythms under normal physiological conditions. However, it may be involved in responding to metabolic challenges or in other aspects of physiology that contribute to voluntary activity levels.

The circadian E3 ligase complex SCFFBXL3+CRY targets TLK2.

We recently demonstrated that the circadian clock component CRY2 is an essential cofactor in the SCFFBXL3-mediated ubiquitination of c-MYC. Because our demonstration that CRY2 recruits phosphorylated substrates to SCFFBXL3 was unexpected, we investigated the scope of this role by searching for additional substrates of FBXL3 that require CRY1 or CRY2 as cofactors. Here, we describe an affinity purification mass spectrometry (APMS) screen through which we identified more than one hundred potential substrates of SCFFBXL3+CRY1/2, including the cell cycle regulated Tousled-like kinase, TLK2. Both CRY1 and CRY2 recruit TLK2 to SCFFBXL3, and TLK2 kinase activity is required for this interaction. Overexpression or genetic deletion of CRY1 and/or CRY2 decreases or enhances TLK2 protein abundance, respectively. These findings reinforce the idea that CRYs function as co-factors for SCFFBXL3, provide a resource of potential substrates, and establish a molecular connection between the circadian and cell cycle oscillators via CRY-modulated turnover of TLK2.

Conceptualising metabolic disorder in Southern Africa: Biology, history and global health.

This paper traces the history of the concept of metabolic disorder in global health and its application to the collection of health metrics relating to the 'epidemic' of non-communicable diseases in Southern Africa, with a focus on Malawi. Although the contemporary science of metabolism points to complexity and contingency, the application of a simplified version of 'metabolic disorder' or 'metabolic syndrome' as the supposed central driver of non-communicable disease in low- and middle-income countries runs the risk of obscuring the ways in which local circumstances and histories interact with global forces to produce epidemiological change. The paper discusses health data collection and its interpretation in Malawi to demonstrate how the use of this concept has led to a narrowing of the category of non-communicable disease and a neglect of the role of infectious disease in producing chronic conditions. Finally, the paper points to alternative approaches which might yield a better understanding of pressing health problems.

A Research Enclave in 1940s Nigeria: The Rockefeller Foundation Yellow Fever Research Institute at Yaba, Lagos, 1943-49.

This article examines the history of yellow fever research carried out in West Africa in the 1940s by Rockefeller Foundation scientists. It engages with a number of debates in the history of medical research in colonial Africa, including experimentation, the construction of the "field," and biosecurity.

Use of Acupuncture in the United States Military Healthcare System.

Objectives: The Military Healthcare System (MHS) shows increasing interest in acupuncture as an alternative to opioids for pain control. However, specific factors associated with this procedure in the MHS are not well-described in literature. This study examines usage within the MHS to determine patterns among the diagnoses, provider types, and facilities associated with acupuncture. Materials and Methods: Acupuncture-treated patients were identified from TRICARE claims data in the MHS Data Repository as having at least one acupuncture treatment in fiscal year (FY) 2014. Bivariate analysis was performed to determine demographics, diagnoses, and number of visits, for both active-duty and nonactive-duty personnel. Descriptive statistics were used to show associated provider and facility types. Results: A total of 15,761 people received acupuncture in the MHS in FY 2014. Use of acupuncture was greater for Army service, white race, and senior enlisted rank overall, and for males ages 26-35 among active-duty and females ages 46-64 among nonactive-duty beneficiaries. A cumulative 76% of diagnoses were for musculoskeletal or nerve and system issues. Approximately 60% of patients received acupuncture from physicians, 16% from physical therapists or chiropractors, and 9.7% from physician extenders. Specific acupuncture techniques (traditional, auricular, etc.) could not be determined from the data set. Conclusions: The most common diagnoses associated with acupuncture are consistent with pain management. However, full analysis is hampered by inconsistent coding and lack of granularity regarding specific techniques. Given the popularity of acupuncture in the MHS, further research is necessary to explore the full scope of this intervention.

Dietary change, noncommunicable disease and local knowledge: results of a small-scale study of the views of older Malawians.

Interviews were conducted with a small group of Malawians over the age of 60 in rural Karonga district and in Area 25 of the capital, Lilongwe. We asked their views on the changes in diet that had taken place over their lifetimes and also on the causes of 'noncommunicable' diseases, such as Type 2 diabetes and hypertension in their communities. Their answers generally confirmed research showing that dietary diversity is decreasing in Malawi, but many of our interviewees also recalled that hunger was more frequently experienced in the past. Our interviews revealed that though the essential rural diet based on either maize or cassava appears superficially largely unchanged, there have been significant changes in the varieties of crops grown, methods of production and food processing. Many of our interviewees were concerned that the application of chemical fertiliser and pesticides was harming their health.