BACKGROUND: Sepsis is a life-threatening condition characterized by a dysregulation of the host response to infection that can lead to acute lung injury (ALI) and multiple organ dysfunction syndrome (MODS). Interleukin 6 (IL-6) is a pro-inflammatory cytokine that plays a crucial role in the pathogenesis of sepsis and its complications.
OBJECTIVE: To investigate the relationship among plasma IL-6 levels, risk of ALI, and disease severity in critically ill patients with sepsis.
METHODS: This prospective and observational study was conducted in the intensive care unit of a tertiary care hospital between January 2021 and December 2022. A total of 83 septic patients were enrolled. Plasma IL-6 levels were measured upon admission using an enzyme-linked immunosorbent assay. The development of ALI and MODS was monitored during hospitalization. Disease severity was evaluated by Acute Physiology and Chronic Health Evaluation II (APACHE II) and Sequential Organ Failure Assessment (SOFA) scores.
RESULTS: Among the 83 patients with sepsis, 38 (45.8%) developed ALI and 29 (34.9%) developed MODS. Plasma IL-6 levels were significantly higher in patients who developed ALI than in those without ALI (median: 125.6 pg/mL vs 48.3 pg/mL; P < 0.001). Similarly, patients with MODS had higher IL-6 levels than those without MODS (median: 142.9 pg/mL vs 58.7 pg/mL; P < 0.001). Plasma IL-6 levels were strongly and positively correlated with APACHE II (r = 0.72; P < 0.001) and SOFA scores (r = 0.68; P < 0.001).
CONCLUSIONS: Elevated plasma IL-6 levels in critically ill patients with sepsis were associated with an increased risk of ALI and MODS. Higher IL-6 levels were correlated with greater disease severity, as reflected by higher APACHE II and SOFA scores. These findings suggest that IL-6 may serve as a biomarker for predicting the development of ALI and disease severity in patients with sepsis.

Purpose: Changes in meibum composition and quantity in meibomian gland dysfunction (MGD) result in tear film instability and dry eye. This exploratory study aimed to identify changes in (O-acyl)-ω-hydroxy fatty acid (OAHFA) and hydrocarbon chain (HC) unsaturation levels in meibum related to the presence and severity of MGD. Methods: Meibum samples were collected from 3 cohorts of adults with no MGD, mild-to-moderate MGD, and severe MGD in a noninterventional clinical trial (NCT01979887). OAHFAs, cholesterol esters (CE), HC unsaturation, and HC length in the meibum samples were quantified with 1H-nuclear magnetic resonance spectroscopy using 2 methods of normalization. Results: Meibum samples from 62 subjects were analyzed: 21 non-MGD, 21 mild-to-moderate MGD, and 20 severe MGD. Meibum OAHFA and CE levels and HC unsaturation were reduced with increasing severity of MGD, with most pairwise comparisons significant (P < 0.05, t-tests), following the order non-MGD > mild-to-moderate MGD > severe MGD. Regardless of the resonances used for normalization, each pairwise comparison of OAHFA, CE, and HC unsaturation levels in MGD (combined severities) versus non-MGD samples was significant (P < 0.01, t-test). Analysis using various normalization equations showed reductions of 20%-22% for OAHFAs, 51%-57% for CE, and 36%-66% for HC unsaturation in MGD (combined severities) compared with non-MGD. HC length was not altered in MGD (combined severities) compared with non-MGD samples (t-test). Conclusions: Meibum OAHFA, CE, and HC unsaturation levels were reduced in MGD and were lowest in the severe MGD cohort. These findings may contribute to the understanding of the pathophysiology of MGD.

BACKGROUND: Traditional approaches to monitoring health inequalities predominantly rely on headcount methods. However, these methods fail to reflect the non-linear health economic implications of changes in disease severity. Alternative, distribution-sensitive metrics are available which could more adequately inform financial planning and policy decision making.
METHODS: We describe the design of the Foster-Greer-Thorbecke (FGT) index, and discuss its relative merits as a summary monitoring metric of health inequalities in the population, compared to the Erreygers concentration index. We illustrate the FGT index by conducting a comparative longitudinal analysis of adult excess inequalities in England using Health Survey for England data from 2009 to 2019.
RESULTS: Excess weight inequalities have steadily increased in the English adult population, especially over the last five years. Going beyond headcount, the FGT index analyses revealed that, unlike the rest of the population, the average overweight adult from the most socio-economically deprived group is either obese (30.3 BMI for females) or at the brink of obesity (29.1 BMI for males). These results underscore a deepening divide in obesity severity between communities, with the most socioeconomically deprived groups being increasingly and disproportionally affected.
CONCLUSIONS: The FGT index can address some shortcomings of traditional approaches to inequality measurement and local governments should consider adopting it as an alternative population health metric. Future research should apply and develop more refined distribution-sensitive measures of health inequality.

UNASSIGNED: To investigate the effect and correlation of serum SIRT1 combined with uterine hemodynamic parameters on disease severity and fetal uterine growth restriction in the progression of preeclampsia, and to evaluate its clinical value as potential markers.
UNASSIGNED: A total of 100 patients with preeclampsia who were hospitalized in Qufu Normal University Hospital from June 2017 to June 2021 were selected as the research objects. According to the severity, they were divided into Mild group (62 cases) and Severe group (38 cases), and according to whether the fetal growth restriction was combined or not, they were divided into the Combined fetal growth restriction group (56 cases) and the Uncomplicated fetal growth restriction group (44 cases). Serum SIRT1 levels and uterine artery hemodynamic parameters were detected, and spearman analysis was used to evaluate the association of serum SIRT1 levels and uterine artery hemodynamic parameters (peak-to-trough ratio of arterial blood velocity, pulsatility index, resistance index) with disease severity (systolic blood pressure, diastolic blood pressure, and random urinary protein levels) and fetal growth restriction (femoral length, biparietal diameter, head circumference and neonatal weight); unsupervised PCA analysis, supervised PLS-DA analysis, Cluster heat map analysis, ROC curve and AUC analysis were used to evaluate the diagnostic value of serum SIRT1 levels combined with uterine artery hemodynamic parameters in the severity of disease and fetal growth restriction in patients with preeclampsia.
UNASSIGNED: Serum SIRT1 levels was decreased in patients with severe preeclampsia (p < 0.0001), arterial blood flow velocity peak-to-trough ratio, pulsatility index and resistance index were increased (p < 0.001; p < 0.0001), and serum SIRT1 levels and uterine artery hemodynamic parameters were closely related to disease severity (p < 0.001; p < 0.0001). In addition, the levels of serum SIRT1 in patients with preeclampsia combined with fetal growth restriction was decreased (p < 0.0001), the peak-to-trough ratio of arterial blood flow velocity, pulsatility index and resistance index were increased (p < 0.0001), and serum SIRT1 levels and uterine artery hemodynamics were closely related to fetal growth restriction (p < 0.0001). Unsupervised PCA analysis and supervised PLS-DA analysis showed that patients with different severity of disease and patients with or without fetal growth restriction were similar within groups, and there were significant differences between groups; cluster heat map analysis showed that mild and severe groups were stratified clustering, the combined fetal growth restriction group and the uncombined group were hierarchically clustered; ROC curve and AUC analysis showed that serum SIRT1 levels combined with uterine artery hemodynamic parameters had a significant effect on the severity of preeclampsia and whether combined with fetal growth restriction high diagnostic value.
UNASSIGNED: Serum SIRT1 combined with uterine hemodynamic parameters in preeclampsia is closely related to disease severity and fetal growth restriction, and is expected to become potential biomarkers for early clinical intervention in patients.
UNASSIGNED: Cilj je bio da se ispita efekat i korelacija serumskog SIRT1 u kombinaciji sa hemodinamskim parametrima materice na težinu bolesti i restrikciju fetalnog rasta materice u progresiji preeklampsije, i da se proceni njihova klinička vrednost kao potencijalnih markera.
UNASSIGNED: Kao objekti istraživanja odabrano je ukupno 100 pacijenata sa preeklampsijom koji su bili hospitalizovani u Univerzitetskoj bolnici Kufu Normal od juna 2017. do juna 2021. godine. Po težini su podeljeni u blagu grupu (62 slučaja) i tešku grupu (38 slučajeva), a prema tome da li je ograničenje rasta fetusa kombinovano ili ne, podeljeni su u grupu kombinovanog ograničenja rasta fetusa (56 slučajeva) i grupa za ograničenje rasta fetusa bez komplikacija (44 slučaja). Detektovani su nivoi SIRT1 u serumu i hemodinamski parametri uteralne arterije, a Spirmanova analiza je korišćena za procenu povezanosti nivoa SIRT1 u serumu i hemodinamskih parametara uteralne arterije (odnos vrha do najniže vrednosti brzine arterijske krvi, indeksa pulsiranja, indeksa otpornosti) sa ozbiljnošću bolesti (sistolni krvni pritisak, dijastolni krvni pritisak i nasumični nivoi proteina u urinu) i ograničenje rasta femura (dužina femura, biparietalni prečnik, obim glave i neonatalna težina). Nenadzirana PCA analiza, nadgledana PLS-DA analiza, analiza klaster toplotne mape, ROC kriva i AUC analiza korišćene su za procenu dijagnostičke vrednosti nivoa SIRT1 u serumu u kombinaciji sa hemodinamskim parametrima uteralne arterije u težini bolesti i ograničenju rasta fetusa kod pacijenata sa preeklampsijom.
UNASSIGNED: Nivoi SIRT1 u serumu su smanjeni kod pacijenata sa teškom preeklampsijom (p < 0,0001), odnos brzine protoka arterijske krvi do najniže vrednosti, indeks pulsacije i indeks otpornosti su povećani (p < 0,001; p < 0,0001), a nivoi SIRT1 u serumu i materice hemodinamski parametri arterije bili su usko povezani sa težinom bolesti (p < 0,001; p < 0,0001). Pored toga, nivoi serumskog SIRT1 kod pacijenata sa preeklampsijom u kombinaciji sa ograničenjem rasta fetusa su smanjeni (p < 0,0001), povećan je odnos pik-na-niže brzine arterijskog krvotoka, indeks pulsacije i indeks otpornosti (p < 0,0001) , a nivoi SIRT1 u serumu i hemodinamika uteralne arterije bili su usko povezani sa ograničenjem rasta fetusa (p < 0,0001). Nenadzirana PCA analiza i nadgledana PLS-DA analiza su pokazale da su pacijenti sa različitom težinom bolesti i pacijenti sa ili bez ograničenja fetalnog rasta bili slični unutar grupa, i da su postojale značajne razlike izme|u grupa. Analiza klaster toplotne mape je pokazala da su blage i teške grupe bile stratifikovane u grupisanje, kombinovana grupa za ograničenje fetalnog rasta i nekombinovana grupa su hijerarhijski grupisane; ROC kriva i AUC analiza su pokazale da nivoi SIRT1 u serumu u kombinaciji sa hemodinamskim parametrima uteralne arterije imaju značajan uticaj na težinu preeklampsije i da li su kombinovani sa ograničenjem rasta fetusa visoku dijagnostičku vrednost.
UNASSIGNED: Serum SIRT1 u kombinaciji sa hemodinamskim parametrima materice kod preeklampsije je usko povezan sa težinom bolesti i ograničenjem rasta fetusa, i očekuje se da će postati potencijalni biomarkeri za ranu kliničku intervenciju kod pacijenata.

Aim: This study intended to investigate the ability of blood MALT1 to estimate acute exacerbation risk in elderly chronic obstructive pulmonary disease (COPD) patients. Methods: Blood MALT1 was detected in 176 elderly COPD patients (aged more than 60 years). Results: MALT1 was elevated in patients with COPD acute exacerbation versus patients with stable COPD (p < 0.001). In patients with COPD acute exacerbation, MALT1 was negatively related to forced expiratory volume in 1 s (FEV1)/forced vital capacity (FVC) (p = 0.024) and FEV1% predicted (p = 0.002), but positively linked with global initiative for chronic obstructive lung disease stage (p = 0.005). Conclusion: Blood MALT1 reflects increased acute exacerbation risk and inflammation in elderly COPD patients.
[Box: see text].

Aim: To investigate the association between plasma AAT level and glaucoma. Methods: 163 glaucoma patients and 111 healthy controls were recruited. The plasma AAT levels were measured by ELISA. Results: Plasma AAT level was significantly higher in glaucoma patients than those in healthy controls (p < 0.001). Patients with higher plasma AAT level exhibited severer disease stage (early vs. severe: p < 0.05; H-P-A; early vs. severe: p < 0.05; early vs. end-stage: p < 0.01; AGIS). ROC curves yielded that AAT can distinguish patients with early glaucoma from those with advanced glaucoma (early vs. severe: AUC: 0.616; H-P-A; early vs. severe: AUC: 0.763; early vs. end-stage: AUC: 0.660; AGIS). Conclusion: Plasma AAT is a useful biomarker for the identification of glaucoma severity.
[Box: see text].

BACKGROUND: TB is a leading infectious cause of death worldwide. The COVID-19 pandemic raised concerns that the burden of TB disease and death would increase due to the synergy between the two conditions.
METHODS: We used individual-level data submitted to the WHO Global Clinical Platform for COVID-19 on hospitalised patients to explore associations of TB with mortality using multivariable logistic regression.
RESULTS: Data were available from 453,233 persons with COVID-19 and known TB status and mortality outcomes from 62 countries (96% SARS-CoV-2 test-positive). Of these, 48% were male, and the median age was 53 years (IQR 38-67). There were 8,214 cases with current TB reported by 46 countries, mainly from Africa. Of people with current TB, 31.4% were admitted with severe illness, and 24.5% died. Current TB was independently associated with higher mortality when adjusted for age, sex, HIV status, illness severity at hospital admission, and underlying conditions (adjusted RR 1.47, 95% CI 1.35-1.61).
CONCLUSIONS: Current or past TB were independent risk factors for in-hospital mortality regardless of illness severity at admission. Caveats for interpretation include changes during the data collection period (viral variation, vaccination coverage) and opportunistic sampling. However, the platform exemplifies how timely, coordinated global reporting can inform our understanding of health emergencies and the vulnerable populations affected.
BACKGROUND: La TB est l\'une des principales causes infectieuses de décès dans le monde. La pandémie de COVID-19 a fait craindre que le fardeau de la TB et des décès n\'augmente en raison de la synergie entre les deux maladies.
UNASSIGNED: Nous avons utilisé les données individuelles soumises à la Plateforme clinique mondiale de l\'OMS pour la COVID-19 sur les patients hospitalisés pour explorer les associations entre la TB et la mortalité à l\'aide d\'une régression logistique multivariée.
UNASSIGNED: Des données étaient disponibles sur 453 233 personnes atteintes de COVID-19 et connues pour le statut de TB et les résultats de mortalité dans 62 pays (96% de tests positifs au SRAS-CoV-2). Parmi eux, 48% étaient des hommes et l\'âge médian était de 53 ans (IQR 38–67). Un total de 8 214 cas de TB ont été signalés par 46 pays, principalement en Afrique. Parmi les personnes atteintes de TB actuelle, 31,4% ont été admises avec une maladie grave et 24,5% sont décédées. La TB actuelle était indépendamment associée à une mortalité plus élevée lorsqu\'elle était ajustée en fonction de l\'âge, du sexe, du statut VIH, de la gravité de la maladie à l\'admission à l\'hôpital et des affections sous-jacentes (RR ajusté 1,47 ; IC à 95% 1,35–1,61).
CONCLUSIONS: La TB actuelle ou passée était un facteur de risque indépendant de mortalité à l\'hôpital, quelle que soit la gravité de la maladie à l\'admission. Les mises en garde concernant l\'interprétation comprennent les changements au cours de la période de collecte des données (variation virale, couverture vaccinale) et l\'échantillonnage opportuniste. Cependant, la plateforme illustre comment des rapports mondiaux opportuns et coordonnés peuvent éclairer notre compréhension des urgences sanitaires et des populations vulnérables touchées.

UNASSIGNED: To determine how the health state of ulcerative colitis patients is impacted by their disease, different health state questionnaires are deployed. This study examines to what extent these health state questionnaires determine the same underlying health state concept and to what extent the complementary use of the health state questionnaires has added value for physicians.
UNASSIGNED: In total, 307 patients were enrolled in this cross-sectional multicenter cohort study. Medical, psychological, economic, and composite health state questionnaires were administered to determine reliability, convergent validity, and explained variance. Reliability was determined using Cronbach\'s alpha. Convergent validity was measured using Spearman\'s correlation coefficients. Explained variance was interpreted using R-squared coefficients.
UNASSIGNED: All questionnaires can be considered reliable. The medical, psychological, and economic health state questionnaires show weak to moderate convergent validity with each other. The medical, psychological, and economic health state questionnaires also explain limited variance in each other\'s outcomes. The composite health state questionnaire shows moderate to strong convergent validity with the other health state questionnaires. The composite health state questionnaire further explains considerable variance in the outcomes of the other health state questionnaires.
UNASSIGNED: Deploying divergent medical, psychological, and economic health state questionnaires may have added value as they provide a multiperspective holistic insight into patients\' health states. Deploying the composite health state questionnaire combined with other health state questionnaires may have added value as it provides additional understanding of their outcomes. Deploying an independent psychological health state questionnaire may have added value as it shows particularly limited convergent validity and explained variance regarding other health state questionnaires.

OBJECTIVE: To develop and validate the Oral Lichen Planus-Disease Activity Scale (OLP-DAS) for assessing overall disease activity of OLP.
METHODS: The OLP-DAS was created by refining the Thongprasom criteria, incorporating inputs from the literature and expert review, and integrating pain assessment. Content validity was evaluated in a virtual meeting with 8 Oral Medicine specialists. Reliability and validity of the final version were examined. Seventeen OLP subjects were assessed for disease activity by 10 investigators using the OLP-DAS, Oral Disease Severity Score (ODSS), OLP-Investigator Global Assessment (OLP-IGA), and Reticular-Erythema-Ulcerative (REU) scale. Convergent validity was assessed by rating 160 OLP subjects using the OLP-DAS, ODSS, and OLP-IGA. Inter-rater and intra-rater reliability, along with convergent validity, were analyzed using intraclass correlation coefficients (ICCs) and Spearman\'s rank correlation coefficients (rs).
RESULTS: The final OLP-DAS achieved excellent content validity indices. Inter-rater and intra-rater ICCs for total OLP-DAS scores were 0.93 and 0.96, respectively. Total OLP-DAS scores exhibited strong positive correlations with the ODSS and OLP-IGA (rs = 0.94 and rs = 0.76; P < 0.001, respectively). The OLP Severity Index (OLP-SI), a component of the OLP-DAS, showed very strong positive correlations with OLP disease activity parameters of the ODSS (rs = 0.90; P < 0.001).
CONCLUSIONS: The OLP-DAS is a valid and reliable clinician-reported outcome measure (CROM) for evaluating OLP disease activity.
CONCLUSIONS: The OLP-DAS, as a standardized CROM for OLP, is valuable for both routine clinical assessments and research applications.

OBJECTIVE: To evaluate the impact of smoking statuses on disease severity and subcutaneous immunotherapy (SCIT) efficacy in allergic rhinitis (AR).
METHODS: Open observational cohort study.
METHODS: Tertiary referral center.
METHODS: Five hundred and five AR patients undergoing dust mite allergen SCIT were categorized into never smokers, former smokers, and current smokers. AR severity was assessed using widely employed questionnaires. The changes in questionnaire scores pre- and post-SCIT were evaluated for SCIT efficacy. The differences in disease severity and SCIT efficacy were compared for different smoking statuses among AR patients.
RESULTS: Compared to never smokers, former and current smokers exhibited higher proportion of male, alcohol, and asthma (P < .05). Current smokers had a greater prevalence of allergic conjunctivitis than former smokers (P < .05). Before SCIT, AR severity was similar across 3 groups, even after adjusting for confounders (P > .05). Current smokers reported lower SCIT efficacy in the first year (P < .05). By the third year, 3 groups showed comparable long-term efficacy (P > .05). However, current smokers experienced a significant decrease in benefits 2 years post-SCIT (P < .05) and lower improvement rates at the end of the 3-years SCIT period and 2 years following SCIT (P < .05).
CONCLUSIONS: AR patients across different smoking statuses demonstrated similar baseline disease severity and long-time SCIT efficacy. Active smoking was associated with increased asthma risk, delayed early SCIT efficacy perception, reduced improvement over 3 years, and diminished benefits 2 years after SCIT. Prompt smoking cessation is crucial to mitigate these effects.