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1.
J Environ Manage ; 366: 121882, 2024 Jul 17.
Artigo em Inglês | MEDLINE | ID: mdl-39025010

RESUMO

Based on current evidence and established critical thresholds for soil degradation indicators, it is concerning that over 60-70% of European soils are unhealthy due to unsustainable management and the impact of climate change. Despite European and national efforts to improve soil health, significant gaps remain. The proposal for a Soil Monitoring and Resilience Law, to be implemented by the European Union, seeks to establish a framework for soil monitoring and promote sustainable management practices to achieve healthy soils by 2050. This requires extensive data collection and soil monitoring systems to accurately estimate soil health across Europe, considering the diversity of soil types, climates, and land uses. To establish a framework for soil monitoring, we must understand the site-specific status of soil and the ranges of soil health indicators across specific pedoclimatic regions. In our study, we evaluated the soil status in agricultural areas in Denmark using soil health indicators and a site-specific benchmarking approach. We compiled nationally representative datasets, combining point and model-informed data of soil parameters such as organic carbon content, bulk density, pH, electrical conductivity, clay-to-soil organiccarbon ratio, water erosion, and nitrogen leaching. By categorizing Danish agricultural soils into monitoring units based on textural classes, landscape elements, and wetland types, we calculated benchmarks for these indicators, considering different cropping systems. Our approach provided detailed point-based results and a spatially explicit overview of the status of soil health indicators in Denmark. We identified areas where soil deviates from the benchmarks of different indicators. Such deviations might indicate soil functions operating outside the normal range, posing potential threats to soil health. This proposed framework could support the establishment of a baseline for assessing the directionality of future changes in soil health. Moreover, it is adaptable for implementation by other countries to support assessments of soil health.

2.
medRxiv ; 2024 Jul 08.
Artigo em Inglês | MEDLINE | ID: mdl-39040190

RESUMO

Background: Post-acute sequelae of SARS-CoV-2, referred to as "long COVID", are a globally pervasive threat. While their many clinical determinants are commonly considered, their plausible social correlates are often overlooked. Methods: Here, we use data from a multinational prospective cohort study to compare social and clinical predictors of differences in quality of life with long COVID. We further measure the extent to which clinical intermediates may explain relationships between social variables and quality of life with long COVID. Findings: Beyond age, neuropsychological and rheumatological comorbidities, educational attainment, employment status, and female sex were important predictors of long COVID-associated quality of life days (long COVID QALDs). Furthermore, most of their associations could not be attributed to key long COVID-predicting comorbidities. In Norway, 90% (95% CI: 77%, 100%) of the adjusted association between belonging to the top two quintiles of educational attainment and long COVID QALDs was not explained by these clinical intermediates. The same was true for 86% (73%, 100%) and 93% (80%,100%) of the adjusted association between full-time employment and long COVID QALDs in the United Kingdom (UK) and Russia. Additionally, 77% (46%,100%) and 73% (52%, 94%) of the adjusted associations between female sex and long COVID QALDs in Norway and the UK were unexplained by the clinical mediators. Interpretation: Our findings highlight that socio-economic proxies and sex are key predictors of long COVID QALDs and that other (non-clinical) mechanisms drive their observed relationships. Importantly, we outline a multi-method, adaptable causal approach for evaluating the isolated contributions of social disparities to experiences with long COVID. Funding: UK Foreign, Commonwealth and Development Office; Wellcome Trust; Bill & Melinda Gates Foundation; Oxford COVID-19 Research Response Funding; UK National Institute for Health and Care Research; UK Medical Research Council; Public Health England; Liverpool Experimental Cancer Medicine Centre; Research Council of Norway; Vivaldi Invest A/S; South Eastern Norway Health Authority.

3.
Environ Pollut ; 357: 124414, 2024 Jun 20.
Artigo em Inglês | MEDLINE | ID: mdl-38908677

RESUMO

Plastic pollution has reached concerning levels globally, with single-use plastic products (SUPs) comprising at least 50% of plastic waste. This study investigates the physical and chemical degradation of frequently used SUPs, including petroleum-based and bio-based plastics, in natural Northern European coastal weather and marine environments over a three-year period from 2019 to 2022. Addressing a critical knowledge gap, this research was based on a hypothesis that real-world ageing studies on SUPs would produce more accurate time- and process-lines for their transformation from macro-to microplastics than are available today based on the modeling studies more frequently used. The study employs optical examination, mechanical testing, Fourier Transform Infrared (FTIR) spectroscopy, and Gas Chromatography-Mass Spectrometry (GC-MS) to determine and relate physical and chemical changes with time. The results indicate that SUPs undergo significantly faster degradation in natural weather than predicted to date. Photooxidation emerges as the primary degradation pathway for all SUPs, emphasizing the role of light in plastic breakdown. Importantly, physical degradation to microplastics in natural environments is not always associated with significant chemical changes such as breaking chemical bonds. Black SUPs exhibit greater resistance to visible light and ultraviolet radiation than equivalent white and transparent examples. In marine environments, SUPs degrade measurably slower than in air, their degradation slowing with increasing distance from the water surface. Our findings indicate the urgent need for strategies that mitigate the impacts of photo-oxidation of SUPs. Such strategies may include a focus on the removal of post-use SUPs from pavements, roads, beaches, and water surfaces where photo-oxidation is faster than underwater and underground. Preferential use of black SUPs over white or transparent should also be considered.

4.
Artigo em Inglês | MEDLINE | ID: mdl-38923495

RESUMO

BACKGROUND: Access to the neuraxial space, including lumbar punctures and neuraxial anaesthesia, is an everyday procedure in clinical practice. Traditionally these procedures rely on manual palpation technique, but ultrasound is a useful tool when patients prove challenging. Presently, there is a lack of evidence-based guidelines for technical skills acquisition, both with and without ultrasound, and likewise, competency assessment approaches vary globally. Accordingly, we aim to assess the current evidence regarding learning and assessment in neuraxial access ± $$ \pm $$ ultrasound, for future educational recommendations. METHODS: This scoping review will be conducted in accordance with the Preferred Reporting Items for Systematic and Meta-Analysis (PRISMA) statement, together with the PRISMA Extension for Scoping Reviews. A systematic search strategy will be based on a PICO approach, focusing on physicians, medical students, or nurses being exposed to education, training, or assessment in procedural neuraxial access ± $$ \pm $$ ultrasound. No comparators are obligated, but outcomes should be assessable using the Kirkpatrick four levels of training evaluation. The search will be performed in Cochrane Library, Embase, Medline, Scopus, PubMed, and CINAHL. Independently, two authors will screen the studies and conflicts will be resolved by a third author. Relevant predefined data will be extracted and analysed using a descriptive approach. The quality of the studies will be assessed using the Medical Education Research Study Quality Instrument. DISCUSSION: This scoping review will contribute by presenting gathered evidence of an overview of the different approaches to achieving education and training of technical skills in neuraxial access, and how skills are tested, which could guide research and future recommendations for skills development and assessment.

5.
Artigo em Inglês | MEDLINE | ID: mdl-38939944

RESUMO

BACKGROUND: Over the past decade, ultrasound utilization has increased within anesthesia and intensive care medicine, enhancing patient safety and diagnostic accuracy. However, the frequency of ultrasound usage and operator training in the Nordic countries remain unclear. This project aims to perform a survey on ultrasound availability, daily clinical use, and how ultrasound skills are trained and assessed, among anesthesiologists. METHODS: This online cross-sectional survey will include anesthesiologists from the Nordic countries. The survey will adhere to the CROSS checklist. Survey items will be developed based on a formative model with a conceptual model, consisting of three main parts, including demographics, ultrasound machines and use, and skills development and assessment. The clinical relevance of items will be secured by including anesthesiologists of various levels of experience in the development of the survey. Furthermore, experienced researchers in medical education will participate in the development, contributing with relevant medical educational perspectives. Data will be summarized using a non-parametric descriptive approach. A chi-squared test will examine relevant relationships between certain answers. RESULTS: Results will be published in a peer-reviewed journal and presented at relevant scientific conferences and meetings. CONCLUSION: This study may find a high availability of ultrasound machines and frequent use in the clinical departments. Despite this expected daily use of ultrasound, missing standardized structured skills acquisition and assessment could be uncovered. The results of this study may contribute to mapping various aspects of clinical ultrasound and skills development for further use in research.

6.
Nature ; 629(8014): 1133-1141, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38750368

RESUMO

The N-methyl-D-aspartate (NMDA) receptor is a glutamate-activated cation channel that is critical to many processes in the brain. Genome-wide association studies suggest that glutamatergic neurotransmission and NMDA receptor-mediated synaptic plasticity are important for body weight homeostasis1. Here we report the engineering and preclinical development of a bimodal molecule that integrates NMDA receptor antagonism with glucagon-like peptide-1 (GLP-1) receptor agonism to effectively reverse obesity, hyperglycaemia and dyslipidaemia in rodent models of metabolic disease. GLP-1-directed delivery of the NMDA receptor antagonist MK-801 affects neuroplasticity in the hypothalamus and brainstem. Importantly, targeting of MK-801 to GLP-1 receptor-expressing brain regions circumvents adverse physiological and behavioural effects associated with MK-801 monotherapy. In summary, our approach demonstrates the feasibility of using peptide-mediated targeting to achieve cell-specific ionotropic receptor modulation and highlights the therapeutic potential of unimolecular mixed GLP-1 receptor agonism and NMDA receptor antagonism for safe and effective obesity treatment.


Assuntos
Maleato de Dizocilpina , Peptídeo 1 Semelhante ao Glucagon , Receptor do Peptídeo Semelhante ao Glucagon 1 , Obesidade , Receptores de N-Metil-D-Aspartato , Animais , Humanos , Masculino , Camundongos , Ratos , Tronco Encefálico/metabolismo , Tronco Encefálico/efeitos dos fármacos , Modelos Animais de Doenças , Maleato de Dizocilpina/efeitos adversos , Maleato de Dizocilpina/farmacologia , Maleato de Dizocilpina/uso terapêutico , Dislipidemias/tratamento farmacológico , Dislipidemias/metabolismo , Peptídeo 1 Semelhante ao Glucagon/metabolismo , Receptor do Peptídeo Semelhante ao Glucagon 1/agonistas , Receptor do Peptídeo Semelhante ao Glucagon 1/metabolismo , Hiperglicemia/tratamento farmacológico , Hiperglicemia/metabolismo , Hipotálamo/efeitos dos fármacos , Hipotálamo/metabolismo , Camundongos Endogâmicos C57BL , Plasticidade Neuronal/efeitos dos fármacos , Obesidade/tratamento farmacológico , Obesidade/metabolismo , Ratos Sprague-Dawley , Ratos Wistar , Receptores de N-Metil-D-Aspartato/metabolismo , Receptores de N-Metil-D-Aspartato/antagonistas & inibidores
7.
Chem Mater ; 36(6): 2756-2766, 2024 Mar 26.
Artigo em Inglês | MEDLINE | ID: mdl-38558915

RESUMO

Water is one of the most reactive and abundant molecules on Earth, and it is thus crucial to understand its reactivity with various material families. One of the big unknown questions is how water in liquid and vapor forms impact the fast-emerging class of metal-organic frameworks (MOFs). Here, we discover that high-pressure water vapor drastically modifies the structure and hence the dynamic, thermodynamic, and mechanical properties of MOF glasses. In detail, we find that an archetypical MOF (ZIF-62) is extremely sensitive to heat treatments performed at 460 °C and water vapor pressures up to ∼110 bar. Both the melting and glass transition temperatures decrease remarkably (by >100 °C), and simultaneously, hardness and Young's modulus increase by up to 100% under very mild treatment conditions (<20 bar of hydrothermal pressure). Structural analyses suggest water to partially coordinate to Zn in the form of a hydroxide ion by replacing a bridging imidazolate-based linker. The work provides insight into the role of hot-compressed water in influencing the structure and properties of MOF glasses and opens a new route for systematically changing the thermodynamics and kinetics of MOF liquids and thus altering the thermal and mechanical properties of the resulting MOF glasses.

9.
Clin Physiol Funct Imaging ; 44(4): 303-312, 2024 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-38462744

RESUMO

BACKGROUND: The aim of this study was to examine the test-retest reliability in lower limb muscle strength and rate of torque development (RTD) using isokinetic dynamometry in adults with obesity, with a body mass index (BMI) ≥ 35 kg/m2. METHOD: Thirty-two adults with a BMI of 43.8 ± 6.6 kg/m2 eligible for bariatric surgery were enroled in the study. Isokinetic and isometric knee extensor (KE) and flexor (KF) strength were assessed in an isokinetic dynamometer (Biodex 4) during three test sessions separated by 3-7 days. RESULTS: There were no statistical differences in peak KE and KF torque for any test modalities between sessions. Intraclass correlation (ICC) was 0.91-0.94 between sessions 1 and 2 and 0.94-0.97 between sessions 2 and 3. Standard error of measurement (SEM%) and coefficient of variation (CV) ranged across test sessions from 4.3% to 7.3%. KE RTD showed high test-retest reliability following familiarization, with ICC, CV and SEM% values ranging from 0.84 to 0.90, 13.3%-20.3% and 14.6%-24.9%, respectively. CONCLUSION: Maximal lower limb muscle strength measured by isokinetic dynamometry showed excellent test-retest reliability manifested by small measurement errors and low CV. Reliability was slightly improved by including a familiarization session. KE RTD but not KF RTD demonstrated high test-retest reliability following familiarization. The present data indicate that isokinetic dynamometry can be used to detect even small changes in lower limb muscle strength in adults with obesity.


Assuntos
Cirurgia Bariátrica , Extremidade Inferior , Dinamômetro de Força Muscular , Força Muscular , Músculo Esquelético , Obesidade , Valor Preditivo dos Testes , Torque , Humanos , Reprodutibilidade dos Testes , Masculino , Feminino , Adulto , Obesidade/fisiopatologia , Obesidade/cirurgia , Obesidade/diagnóstico , Pessoa de Meia-Idade , Músculo Esquelético/fisiopatologia , Índice de Massa Corporal , Contração Isométrica , Fatores de Tempo
10.
Comp Med ; 74(2): 55-69, 2024 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-38508697

RESUMO

Disturbances in gut microbiota are prevalent in inflammatory bowel disease (IBD), which includes ulcerative colitis (UC). However, whether these disturbances contribute to development of the disease or are a result of the disease is unclear. In pairs of human twins discordant for IBD, the healthy twin has a higher risk of developing IBD and a gut microbiota that is more similar to that of IBD patients as compared with healthy individuals. Furthermore, appropriate medical treatment may mitigate these disturbances. To study the correlation between microbiota and IBD, we transferred stool samples from a discordant human twin pair: one twin being healthy and the other receiving treatment for UC. The stool samples were transferred from the disease-discordant twins to germ-free pregnant dams. Colitis was induced in the offspring using dextran sodium sulfate. As compared with offspring born to mice dams inoculated with stool from the healthy cotwin, offspring born to dams inoculated with stool from the UC-afflicted twin had a lower disease activity index, less gut inflammation, and a microbiota characterized by higher α diversity and a more antiinflammatory profile that included the presence and higher abundance of antiinflammatory species such as Akkermansia spp., Bacteroides spp., and Parabacteroides spp. These findings suggest that the microbiota from the healthy twin may have had greater inflammatory properties than did that of the twin undergoing UC treatment.


Assuntos
Colite Ulcerativa , Microbioma Gastrointestinal , Animais , Colite Ulcerativa/microbiologia , Humanos , Camundongos , Feminino , Vida Livre de Germes , Sulfato de Dextrana/toxicidade , Fezes/microbiologia , Gravidez , Masculino , Modelos Animais de Doenças , Transplante de Microbiota Fecal
11.
Arterioscler Thromb Vasc Biol ; 44(5): 1144-1155, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38511326

RESUMO

BACKGROUND: Elevated apoB-containing lipoproteins (=remnants+LDLs [low-density lipoproteins]) are a major risk factor for atherosclerotic cardiovascular disease, including peripheral artery disease (PAD) and myocardial infarction. We tested the hypothesis that remnants and LDL both explain part of the increased risk of PAD conferred by elevated apoB-containing lipoproteins. For comparison, we also studied the risk of chronic limb-threatening ischemia and myocardial infarction. METHODS: apoB, remnant cholesterol, and LDL cholesterol were measured in 93 461 individuals without statin use at baseline from the Copenhagen General Population Study (2003-2015). During up to 15 years of follow-up, 1207 had PAD, 552 had chronic limb-threatening ischemia, and 2022 had myocardial infarction in the Danish National Patient Registry. Remnant and LDL cholesterol were calculated from a standard lipid profile. Remnant and LDL particle counts were additionally measured with nuclear magnetic resonance spectroscopy in 25 347 of the individuals. Results were replicated in 302 167 individuals without statin use from the UK Biobank (2004-2010). RESULTS: In the Copenhagen General Population Study, multivariable adjusted hazard ratios for risk of PAD per 1 mmol/L (39 mg/dL) increment in remnant and LDL cholesterol were 1.9 (95% CI, 1.5-2.4) and 1.1 (95% CI, 1.0-1.2), respectively; corresponding results in the UK Biobank were 1.7 (95% CI, 1.4-2.1) and 0.9 (95% CI, 0.9-1.0), respectively. In the association from elevated apoB to increased risk of PAD, remnant and LDL cholesterol explained 73% (32%-100%) and 8% (0%-46%), respectively; corresponding results were 63% (30%-100%) and 0% (0%-33%) for risk of chronic limb-threatening ischemia and 41% (27%-55%) and 54% (38%-70%) for risk of myocardial infarction; results for remnant and LDL particle counts corroborated these findings. CONCLUSIONS: PAD risk conferred by elevated apoB-containing lipoproteins was explained mainly by elevated remnants, while myocardial infarction risk was explained by both elevated remnants and LDL.


Assuntos
Apolipoproteína B-100 , Biomarcadores , LDL-Colesterol , Colesterol , Lipoproteínas , Doença Arterial Periférica , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Apolipoproteína B-100/sangue , Biomarcadores/sangue , Colesterol/sangue , LDL-Colesterol/sangue , Dinamarca/epidemiologia , Isquemia/sangue , Isquemia/epidemiologia , Isquemia/diagnóstico , Infarto do Miocárdio/epidemiologia , Infarto do Miocárdio/sangue , Infarto do Miocárdio/diagnóstico , Doença Arterial Periférica/epidemiologia , Doença Arterial Periférica/sangue , Doença Arterial Periférica/diagnóstico , Estudos Prospectivos , Sistema de Registros , Medição de Risco , Fatores de Risco , Fatores de Tempo , Triglicerídeos
12.
Br J Dermatol ; 191(2): 209-215, 2024 Jul 16.
Artigo em Inglês | MEDLINE | ID: mdl-38411598

RESUMO

BACKGROUND: It is increasingly clear that triglyceride-rich lipoproteins are proinflammatory and cause low-grade systemic inflammation. However, it is currently unknown whether elevated plasma triglycerides are causally related to the development of psoriasis, a skin disorder driven by chronic inflammation. OBJECTIVES: To determine if elevated plasma triglycerides are associated with increased risk of psoriasis in observational and Mendelian randomization analysis. METHODS: Consecutive individuals from the Copenhagen General Population Study were included. We used plasma triglycerides (n = 108 043) and a weighted triglyceride allele score (n = 92 579) on nine known triglyceride-altering genetic variants. Genetic results were replicated in 337 159 individuals from the UK Biobank. Psoriasis was defined using the International Classification of Diseases, version 10 (ICD-10) code for hospital contact in the main analyses, and prescription of topical antipsoriatics for mild psoriasis in the sensitivity analysis. RESULTS: During a follow-up of median (range) 9.3 (0.1-15.1) years from 2003 to 2015 through 2018, 855 (1%) individuals were diagnosed with psoriasis by ICD-10 in the observational analysis and 772 (1%) in the Mendelian randomization analysis. In the observational analysis, the multivariable adjusted hazard ratio for psoriasis by ICD-10 was 1.26 [95% confidence interval (CI) 1.15-1.39] per doubling in plasma triglycerides with a corresponding causal odds ratio of incident psoriasis of 2.10 (95% CI 1.30-3.38). Causality was confirmed from data from the UK Biobank. Results were similar but slightly attenuated when we used topical antipsoriatic prescriptions for mild psoriasis. CONCLUSIONS: Elevated plasma triglycerides are associated with an increased risk of psoriasis in observational and Mendelian randomization analysis.


Psoriasis is a common skin condition, characterized by inflammation in the body (the body's response to an unwanted agent). People with psoriasis often have higher lipid levels in their blood compared with people without psoriasis. Some studies have shown that triglyceride-rich lipoprotein (a certain type of lipid) is irritative to the body and can cause inflammation. However, it is unclear whether high levels of triglycerides in the blood can cause them to penetrate into the skin and trigger the onset of psoriasis. We aimed to test this question in 100,000 people from a Danish population without previously diagnosed psoriasis. Specifically, we measured plasma triglycerides at initial examination and at the same time assessed the same people for genetic variants that impact on the concentration of plasma triglycerides. Importantly, genetic variants are inherited by chance, meaning that we could look specifically at whether a change in triglycerides was the mechanism that causes psoriasis. Next, we observed these people for about 10 years and noted any new occurrence of psoriasis during follow-up. We found that the risk of developing psoriasis was higher both as a function of plasma triglyceride concentration and the genetic variants that increase plasma triglyceride concentration. Overall, our study findings suggest that high levels of triglycerides in the blood could be a causal risk factor for the development of psoriasis.


Assuntos
Análise da Randomização Mendeliana , Psoríase , Triglicerídeos , Humanos , Psoríase/genética , Psoríase/sangue , Psoríase/epidemiologia , Feminino , Masculino , Triglicerídeos/sangue , Pessoa de Meia-Idade , Adulto , Idoso , Dinamarca/epidemiologia , Fatores de Risco , Predisposição Genética para Doença , Polimorfismo de Nucleotídeo Único , Hipertrigliceridemia/genética , Hipertrigliceridemia/sangue , Hipertrigliceridemia/epidemiologia
14.
Lancet Reg Health Eur ; 36: 100780, 2024 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-38188279

RESUMO

Background: The Fibrosis-4 Index (FIB-4) is used as a non-invasive tool for the presence of advanced liver fibrosis in metabolic dysfunction-associated steatotic liver disease and type 2 diabetes. However, evidence for an association between FIB-4 and risk of mortality and/or liver-related clinical outcomes is limited. The aim of this study was to investigate the association between FIB-4 and subsequent liver events, cardiovascular events, and all-cause mortality in individuals with obesity and/or type 2 diabetes examined in routine general practice. Methods: This was a longitudinal cohort study in which eligible adults had obesity and/or type 2 diabetes and ≥1 FIB-4 score calculable from UK Clinical Practice Research Datalink GOLD after 1 January 2001. No alcohol-related disorders and/or chronic liver diseases (except non-alcoholic fatty liver disease) and/or no prescriptions of drugs inducing liver disease were permitted. Individuals were followed until time of first event, 10 years, or 1 January 2020. Analyses were conducted using Aalen-Johansen cumulative incidence functions and Cox proportional hazards models. Findings: Among 44,481 included individuals (mean age 58·8 years; 54% female), there were 979 liver, 6002 cardiovascular, and 8971 mortality events during the 10 years of follow-up. At 10 years, the cumulative incidence of liver events in the high (>2·67), indeterminate (1·30-2·67), and low (<1·30) baseline FIB-4 risk groups were 15%, 3%, and 1%, respectively. Age- and sex-adjusted hazard ratios (HRs) for liver events were elevated in high (16·46; 95% confidence interval [CI] 13·65-19·85) and indeterminate (2·45; 95% CI 2·07-2·90) versus low FIB-4 risk groups. Similar results were found for cardiovascular events and all-cause mortality. Among 20,433 individuals with ≥2 FIB-4 measurements, increase/decrease in FIB-4 12 months after baseline was directly associated with risk of liver events: compared with individuals with low baseline FIB-4 and no change in FIB-4 (reference), the adjusted HR (95% CI) for those with high baseline FIB-4 was 24·27 (16·98-34·68) with a one-unit FIB-4 increase, and 10·90 (7·90-15·05) with a one-unit decrease. Interpretation: In addition to its value as a diagnostic tool, FIB-4 has clinical utility as a prognostic biomarker. Sequential measurement provides a pragmatic, tractable monitoring biomarker that refines risk assessment for liver events, cardiovascular events, and mortality. Funding: Novo Nordisk A/S.

15.
Acta Anaesthesiol Scand ; 68(1): 91-100, 2024 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-37729943

RESUMO

BACKGROUND: In the Difficult Airway Society's 2015 "cannot intubate, cannot oxygenate" guideline, the emergency cricothyroidotomy is the final option when managing an unanticipated difficult airway. How often training for maintenance of this skill is required for anesthesiologists remains unknown. We aimed to assess if specialist-trained anesthesiologists' skills improved from a brush-up intervention and if skills were retained after 3 months. METHODS: In this multicenter, randomized, controlled trial, participants were randomized to either a simulation-based brush-up or no brush-up. Both groups performed a mannequin-based technical skills emergency cricothyroidotomy test twice and were assessed by a blinded rater using a structured assessment tool that included time, positioning, palpation, appropriate employment of instruments, and stepwise progression. After 3 months of non-training, participants completed identical tests of retention. RESULTS: A total of 54 anesthesiologists were included from three hospitals in the Region of Southern Denmark. Thirty-seven percent of the participants had received skills training in emergency cricothyroidotomy in the prior 12 months. The intervention group (N = 27) performed better in the initial tests, with a mean time of 51.5 s (SD = 10.82), a total score per minute of 15.9 points (SD = 4.91), and 93% passing both initial tests compared to the control group (N = 27) with a mean time of 76.8 s (SD = 35.82), a total score per minute of 6.6 (SD = 4.68) and only 15% passing both initial tests. The intervention group managed to retain overall performance in retention tests in terms of performance time (48.9 s, p = .26), total score per minute (13.6 points, p = .094), and passing the tests (75%, p = .059). CONCLUSION: Exposure to simulation-based brush-up training in emergency cricothyroidotomy improved anesthesiologists' technical performance and was overall retained after 3 months. Some loss of skill concerning specific items was observed, highlighting the need for regular training in emergency cricothyroidotomy. Simulation-based training should be prioritized to improve and maintain technical skills in infrequent high-stakes procedures.


Assuntos
Internato e Residência , Treinamento por Simulação , Humanos , Anestesiologistas , Competência Clínica , Manequins
16.
Ultrasound Med Biol ; 50(2): 277-284, 2024 02.
Artigo em Inglês | MEDLINE | ID: mdl-38040522

RESUMO

OBJECTIVE: Focused assessment with sonography for trauma (FAST) is a valuable ultrasound procedure in emergency settings, and there is a need for evidence-based education in FAST to ensure competencies. Immersive virtual reality (IVR) is a progressive training modality gaining traction in the field of ultrasound training. IVR holds several economic and practical advantages to the common instructor-led FAST courses using screen-based simulation (SBS). METHODS: This prospective, interventional cohort study investigated whether training FAST using IVR unsupervised and out-of-hospital was non-inferior to a historical control group training at a 90 min SBS course in terms of developing FAST competencies in novices. Competencies were assessed in both groups using the same post-training simulation-based FAST test with validity evidence, and a non-inferiority margin of 2 points was chosen. RESULTS: A total of 27 medical students attended the IVR course, and 27 junior doctors attended the SBS course. The IVR group trained for a median time of 117 min and scored a mean 14.2 ± 2.0 points, compared with a mean 13.7 ± 2.5 points in the SBS group. As the lower bound of the 95% confidence interval at 13.6 was within the range of the non-inferiority margin (11.7-13.7 points), training FAST in IVR for a median of 117 min was found non-inferior to training at a 90 min SBS course. No significant correlation was found between time spent in IVR and test scores. CONCLUSION: Within the limitations of the use of a historical control group, the results suggest that IVR could be an alternative to SBS FAST training and suitable for unsupervised, out-of-hospital courses in basic FAST competencies.


Assuntos
Avaliação Sonográfica Focada no Trauma , Realidade Virtual , Humanos , Estudos de Coortes , Estudos Prospectivos , Ultrassonografia , Competência Clínica
17.
Contact Dermatitis ; 89(6): 442-452, 2023 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-37700557

RESUMO

BACKGROUND: Allergic contact dermatitis (ACD) is an inflammatory disease with a complex pathophysiology in which epidermal-resident memory CD8+ T (TRM ) cells play a key role. The mechanisms involved in the activation of CD8+ TRM cells during allergic flare-up responses are not understood. METHODS: The expression of CD100 and its ligand Plexin B2 on CD8+ TRM cells and keratinocytes before and after allergen exposure was determined by flow cytometry and RT-qPCR. The role of CD100 in the inflammatory response during the challenge phase of ACD was determined in a model of ACD in CD100 knockout and wild-type mice. RESULTS: We show that CD8+ TRM cells express CD100 during homeostatic conditions and up-regulate it following re-exposure of allergen-experienced skin to the experimental contact allergen 1-fluoro-2,4-dinitrobenzene (DNFB). Furthermore, Plexin B2 is up-regulated on keratinocytes following exposure to some contact allergens. We show that loss of CD100 results in a reduced inflammatory response to DNFB with impaired production of IFNγ, IL-17A, CXCL1, CXCL2, CXCL5, and IL-1ß and decreased recruitment of neutrophils to the epidermis. CONCLUSION: Our study demonstrates that CD100 is expressed on CD8+ TRM cells and is required for full activation of CD8+ TRM cells and the flare-up response of ACD.


Assuntos
Dermatite Alérgica de Contato , Animais , Camundongos , Alérgenos , Dermatite Alérgica de Contato/metabolismo , Dinitrofluorbenzeno/metabolismo , Queratinócitos/metabolismo , Pele
18.
Diabetologia ; 66(12): 2238-2249, 2023 12.
Artigo em Inglês | MEDLINE | ID: mdl-37776347

RESUMO

AIMS/HYPOTHESIS: Elevated remnant cholesterol is observationally and causally associated with increased risk of atherosclerotic cardiovascular disease (ASCVD) in the general population. This association is not well studied in individuals with diabetes, who are often included in clinical trials of remnant cholesterol-lowering therapy. We tested the hypothesis that elevated remnant cholesterol is associated with increased risk of ASCVD in individuals with diabetes. We also explored the fraction of excess risk conferred by diabetes which can be explained by elevated remnant cholesterol. METHODS: We included 4569 white Danish individuals with diabetes (58% statin users) nested within the Copenhagen General Population Study (2003-2015). The ASCVDs peripheral artery disease, myocardial infarction and ischaemic stroke were extracted from national Danish health registries without losses to follow-up. Remnant cholesterol was calculated from a standard lipid profile. RESULTS: During up to 15 years of follow-up, 236 individuals were diagnosed with peripheral artery disease, 234 with myocardial infarction, 226 with ischaemic stroke and 498 with any ASCVD. Multivariable adjusted HR (95% CI) per doubling of remnant cholesterol was 1.6 (1.1, 2.3; p=0.01) for peripheral artery disease, 1.8 (1.2, 2.5; p=0.002) for myocardial infarction, 1.5 (1.0, 2.1; p=0.04) for ischaemic stroke, and 1.6 (1.2, 2.0; p=0.0003) for any ASCVD. Excess risk conferred by diabetes was 2.5-fold for peripheral artery disease, 1.6-fold for myocardial infarction, 1.4-fold for ischaemic stroke and 1.6-fold for any ASCVD. Excess risk explained by elevated remnant cholesterol and low-grade inflammation was 14% and 8% for peripheral artery disease, 26% and 16% for myocardial infarction, 34% and 34% for ischaemic stroke, and 24% and 18% for any ASCVD, respectively. LDL-cholesterol did not explain excess risk, as it was not higher in individuals with diabetes. We also explored the fraction of excess risk conferred by diabetes which can be explained by elevated remnant cholesterol. CONCLUSIONS/INTERPRETATION: Elevated remnant cholesterol was associated with increased risk of ASCVD in individuals with diabetes. Remnant cholesterol and low-grade inflammation explained substantial excess risk of ASCVD conferred by diabetes. Whether remnant cholesterol should be used as a treatment target remains to be determined in randomised controlled trials.


Assuntos
Aterosclerose , Isquemia Encefálica , Doenças Cardiovasculares , Diabetes Mellitus , Hipercolesterolemia , AVC Isquêmico , Infarto do Miocárdio , Doença Arterial Periférica , Acidente Vascular Cerebral , Humanos , Doenças Cardiovasculares/etiologia , Estudos Prospectivos , Isquemia Encefálica/epidemiologia , Acidente Vascular Cerebral/epidemiologia , Aterosclerose/diagnóstico , Colesterol , Diabetes Mellitus/epidemiologia , Inflamação , Infarto do Miocárdio/epidemiologia , Doença Arterial Periférica/epidemiologia , AVC Isquêmico/complicações , Fatores de Risco
19.
Curr Atheroscler Rep ; 25(11): 795-803, 2023 11.
Artigo em Inglês | MEDLINE | ID: mdl-37768410

RESUMO

PURPOSE OF REVIEW: Recent large clinical trials have failed to show that triglyceride-rich lipoprotein-lowering therapies decrease the risk of atherosclerotic cardiovascular disease (ASCVD). In this review, we reconcile these findings with evidence showing that elevated levels of triglyceride-rich lipoproteins and the cholesterol they contain, remnant cholesterol, cause ASCVD alongside low-density lipoprotein (LDL) cholesterol. RECENT FINDINGS: Results from observational epidemiology, genetic epidemiology, and randomized controlled trials indicate that lowering of remnant cholesterol and LDL cholesterol decrease ASCVD risk by a similar magnitude per 1 mmol/L (39 mg/dL) lower non-high-density lipoprotein cholesterol (remnant cholesterol+LDL cholesterol). Indeed, recent guidelines for ASCVD prevention recommend the use of non-high-density lipoprotein cholesterol instead of LDL cholesterol. Current consensus is moving towards recognizing remnant cholesterol and LDL cholesterols as equals per 1 mmol/L (39 mg/dL) higher levels in the risk assessment of ASCVD; hence, triglyceride-rich lipoprotein-lowering therapies should also lower levels of non-HDL cholesterol to reduce ASCVD risk.


Assuntos
Aterosclerose , Lipoproteínas , Humanos , LDL-Colesterol , Triglicerídeos , Colesterol , Aterosclerose/tratamento farmacológico
20.
Sci Total Environ ; 905: 166921, 2023 Dec 20.
Artigo em Inglês | MEDLINE | ID: mdl-37704130

RESUMO

Future global climate changes are expected to increase soil organic carbon (SOC) decomposition. However, the combined effect of C inputs, land use changes, and climate on SOC turnover is still unclear. Exploring this SOC-climate-land use interaction allows us to understand the SOC stabilization mechanisms and examine whether the soil can act as a source or a sink for CO2. The current study estimates the SOC sequestration potential in the topsoil layer of Danish agricultural lands by 2038, considering the effect of land use change and future climate scenarios using the Rothamsted Carbon (RothC) model. Additionally, we quantified the loss vulnerability of existing and projected SOC based on the soil capacity to stabilize OC. We used the quantile random forest model to estimate the initial SOC stock by 2018, and we simulated the SOC sequestration potential with RothC for a business-as-usual (BAU) scenario and a crop rotation change (LUC) scenario under climate change conditions by 2038. We compared the projected SOC stocks with the carbon saturation deficit. The initial SOC stock ranged from 10 to 181 Mg C ha-1 in different parts of the country. The projections showed a SOC loss of 8.1 Mg C ha-1 for the BAU scenario and 6 Mg C ha-1 after the LUC adoption. This SOC loss was strongly influenced by warmer temperatures and clay content. The proposed crop rotation became a mitigation measure against the negative effect of climate change on SOC accumulation, especially in sandy soils with a high livestock density. A high C accumulation in C-saturated soils suggests an increase in non-complexed SOC, which is vulnerable to being lost into the atmosphere as CO2. With these results, we provide information to prioritize areas where different soil management practices can be adopted to enhance SOC sequestration in stable forms and preserve the labile-existing SOC stocks.

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