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Objective: To describe treatment patterns and direct healthcare costs over 3 years following initiation of standard of care acute and preventive migraine medications in patients with migraine in the United States. Background: There are limited data on long‐term (>1 year) migraine treatments patterns and associated outcomes. Methods: This was a retrospective, observational cohort study using US claims data from the IBM® MarketScan® Research Database (January 2010–December 2017). Adults were included if they had a prescription claim for acute migraine treatments (AMT) or preventive migraine treatments (PMT) in the index period (January 2011–December 2014). The AMT cohort was categorized as persistent, cycled, or added‐on subgroups; the PMT cohort was categorized PMT‐persistent, switched without gaps, or cycled with gaps. Migraine‐specific annual direct costs (2017 US$) across AMT and PMT cohort subgroups were summarized at baseline through 3 years from index (follow‐up). Results: During the index period, 20,778 and 42,259 patients initiated an AMT and a PMT, respectively. At the 3‐year follow‐up, migraine‐specific direct costs were lower in the persistent subgroup relative to the non‐persistent subgroups in both AMT (mean [SD]: $789 [$1741] vs. $2847 [$8149] in the added‐on subgroup and $862 [$5426] for the cycled subgroup) and PMT cohorts (mean [SD]: $1817 [$5892] in the persistent subgroup vs. $4257 [$11,392] in the switched without gaps subgroup and $3269 [$18,540] in the cycled with gaps subgroup). Acute medication overuse was lower in the persistent subgroup (1025/6504 [27.2%]) vs. non‐persistent subgroups (11,236/58,863 [32.2%] in cycled with gaps subgroup and 1431/6504 [39.4%] in the switched without gaps subgroup). Most patients used multiple acute (19,717/20,778 [94.9%]) or preventive (38,494/42,259 [91.1%]) pharmacological therapies over 3 years following treatment initiation. Gaps in preventive therapy were common; an average gap ranged from 85 to 211 days (~3–7 months). Conclusion: Migraine‐specific annual healthcare costs and acute migraine medication overuse remained lowest among patients with persistent AMT and PMT versus non‐persistent treatment. Study findings are limited to the US population. Future studies should compare costs and associated outcomes between newer preventive migraine medications in patients with migraine. Plain Language Summary: Little is known about how patients use medications to acutely treat or prevent migraine over longer periods of time and their associated costs. This study used information from medical and pharmacy claims to understand costs over time for three groups of patients with migraine: (1) those who remained on the same medication for 3 years, (2) those who changed medications, or (3) those who stopped treatment and then changed medications. Results showed that fewer than one in 10 patients stayed on the same medication to treat or prevent migraine over 3 years, but migraine costs and acute migraine medication overuse were lowest in these patients. [ABSTRACT FROM AUTHOR]

Since at least the 1980s, motivated, in part, by findings from international comparisons of students' mathematics achievement, some American (U.S.) educators and policy makers have initiated educational reform that focuses on improving teaching practices and curriculum designs by advocating for the adoption of Asian educational models. The implicit assumption behind such reform seems to overlook the possible roles of outside of school factors in superior academic performance in the Asian countries. The purpose of this study was to investigate how outside of school factors were related to students' TIMSS mathematics achievement for the U.S and five top-performing Asian nations or regions, and to examine whether the relative role of school-associated and outside of school factors was consistent across these five Asian countries. The results indicated that students' achievement was highly related to outside of school factors across all six countries. For Singapore and Hong Kong, school-associated factors had somewhat more salient roles than the outside of school factors. However, for Korea, Taiwan, and Japan, school-associated factors played lessor roles in students' achievement performance. As for the U.S., school-associated factors were related to students' performance, however outside of school factors clearly played more salient roles than the school-associated factors. The findings suggest that students' mathematics achievement covaries substantially with outside of school factors. Hence, students' superior mathematics achievement does not necessarily reflect only a superior public school system but also outside of school factors. (Contains 10 tables and 2 figures.)

Background: The Symptoms of Infection with Coronavirus-19 (SIC) is a 30-item patient-reported outcome (PRO) measure scored by body system composites to assess signs/symptoms of coronavirus disease 2019 (COVID-19). In addition to cross-sectional and longitudinal psychometric evaluations, qualitative exit interviews were conducted to support the content validity of the SIC. Methods: In a cross-sectional study, adults diagnosed with COVID-19 in the United States completed the web-based SIC and additional PRO measures. A subset was invited to participate in phone-based exit interviews. Longitudinal psychometric properties were assessed in ENSEMBLE2, a multinational, randomized, double-blind, placebo-controlled, phase 3 trial of the Ad26.COV2.S COVID-19 vaccine. Psychometric properties evaluated included structure, scoring, reliability, construct validity, discriminating ability, responsiveness, and meaningful change thresholds of SIC items and composite scores. Results: In the cross-sectional study, 152 participants completed the SIC (mean age, 51.0 ± 18.6 years) and 20 completed follow-up interviews. Fatigue (77.6%), feeling unwell (65.8%), and cough (60.5%) were symptoms most frequently reported. SIC inter-item correlations were all positive and mostly moderate (r ≥ 0.3) and statistically significant. SIC items and Patient-Reported Outcomes Measurement Information System-29 (PROMIS-29) scores correlated as hypothesized (all r ≥ 0.32). Internal consistency reliabilities of all SIC composite scores were satisfactory (Cronbach's alpha, 0.69–0.91). SIC composite scores correlated moderately (r = 0.30–0.49) to strongly (r ≥ 0.50) with PROMIS-29 scores and Patient Global Impression of Severity (PGIS) ratings (all P < 0.01). A variety of signs/symptoms were cited in exit interviews, and participants considered the SIC straightforward, comprehensive, and easy to use. From ENSEMBLE2, 183 participants with laboratory-confirmed moderate to severe/critical COVID-19 were included (51.5 ± 14.8 years). Strong test-retest reliabilities were observed for most SIC composite scores (intraclass correlations ≥ 0.60). Statistically significant differences across PGIS severity levels were found for all but 1 composite score, supporting known-groups validity. All SIC composite scores demonstrated responsiveness based on changes in PGIS. Conclusions: The psychometric evaluations provided strong evidence for the reliability and validity of the SIC for measuring COVID-19 symptoms, supporting its use in vaccine and treatment trials. In exit interviews, participants described a broad range of signs/symptoms consistent with previous research, further supporting the content validity and format of the SIC. Plain english summary: Coronavirus disease 2019 (COVID-19) is a serious disease that continues to evolve globally. Researchers developed the Symptoms of Infection with Coronavirus-19 (SIC), a 30-item questionnaire designed for patients to report signs and symptoms of COVID-19. In this study, the researchers formally analyzed how well the SIC measures the patient experience with COVID-19, using survey and clinical trial data as well as telephone interviews. Adults with COVID-19 and at least 2 bothersome symptoms completed the web-based survey, and some of these individuals also participated in in-depth interviews. Participants in a clinical trial for a COVID-19 vaccine also completed the SIC measure. The SIC was compared with other commonly used questionnaires that evaluate patient experience. The most commonly reported symptoms of COVID-19 were fatigue, feeling unwell, cough, weakness, and headache. The items for individual symptoms (e.g., "cough") and combined scores for body systems (e.g., "respiratory system") performed well in statistical analyses. Participants found the SIC to be straightforward, comprehensive, and easy to use. The SIC may prove useful in the future for vaccine and treatment trials for COVID-19. [ABSTRACT FROM AUTHOR]

While some geographers have embraced active learning as a means to engage students in a course, many others stick to conventional teaching methods. They are often deterred by suggestions that it can be difficult to implement active learning where students have no prior knowledge of a subject, that active learning requires too much work of lecturers and students, and that there are significant institutional constraints to implementing active learning. In this article the authors draw on their experiences of utilizing active learning in five different countries before dispelling myths which continue to constrain the uptake of active learning methods. Finally, they provide simple guidelines for successful integration of active learning in geography courses. (Contains 1 table, 1 figure, and 2 notes.)

The Women in Science Scale (WiSS) was first developed in 1984, and is still being used in contemporary studies, yet its psychometric properties have not been evaluated with current statistical methods. In this study, the WiSS was administered in its original 27-item form to 1,439 middle and high school students. Confirmatory factor analysis based upon the original description of the WiSS was modestly supportive of the proposed three-factor structure, but the claimed dimensions showed substantial redundancy. Therefore, we split our sample and performed exploratory factor analyses on one half. The most satisfactory solution, a two-factor model, was then applied to the crossvalidation sample with a confirmatory factor analysis. This two-factor structure was supported with a total of 14 items. Factor 1, "Equality," contains eight items, and factor 2, "Sexism," six items. Although our data are limited to adolescents, the WiSS, with improved psychometric properties, may be used descriptively to assess attitudes toward women in science and with additional stability and repeatability testing, may be used in evaluation research. The shortened WiSS should result in shorter administration time, fewer missing data, and increased acceptance among survey administrators in classroom settings. (Contains 2 figures and 5 tables. Appended are: (1) Peer-Reviewed Studies Using the Women in Science Scale (WiSS); and (2) Dissertation Studies Using the Women in Science Scale (WiSS).) [Additional funding for this article was provided by the Frederic C. Bartter General Clinical Research Center.]

• The exposure of ACEs was significantly associated with all adverse health conditions with a dose-response pattern. • The impact of ACEs on mental health and cognition was greater than that on physical health. • The impact of ACEs on mental health more significant in the elderly than in middle-aged adults. • Mental health may indirectly influence the relationship between ACE and physical health and cognition. The specific effects of adverse childhood experiences (ACEs) in adulthood and senectitude were less known. We aim to examine the relationship between early ACEs and overall health condition as well as specific dimensions in the middle-aged and elderly population. In the 2019–2021 Behavioral Risk Factor Surveillance System Study, robust Poisson regression models were used to estimate the relationship between ACE exposure and current health status among adults aged 45 ≥ years. Of the 195,472 participants, 53.8 % were female and the mean age was 65.0 years. Compared to populations without ACE, ACE exposures were more significantly associated with depression (PR: 2.03, 95 %CI: 1.94–2.21), frequent mental health (PR: 1.85, 95 %CI: 1.74–1.97) and subject cognitive decline (PR: 1.99, 95 %CI:1.85–2.14) than with physical health (PR: 1.37, 95 %CI: 1.32–1.44), with dose-response patterns. The association with mental disorder was especially significant among the elderly population. Early ACEs are associated with adverse health outcomes that persist into later life, particularly mental disorders and cognitive decline. Poor mental health may indirectly influence associations with ACEs and cognitive decline as well as physical health. Our findings emphasize the importance of lifelong psychological screening and support for the ACE-exposed middle-aged and elderly population. [ABSTRACT FROM AUTHOR]

Monitoring new mutations in SARS-CoV-2 provides crucial information for identifying diagnostic and therapeutic targets and important insights to achieve a more effective COVID-19 control strategy. Next generation sequencing (NGS) technologies have been widely used for whole genome sequencing (WGS) of SARS-CoV-2. While various NGS methods have been reported, one chief limitation has been the complexity of the workflow, limiting the scalability. Here, we overcome this limitation by designing a laboratory workflow optimized for high-throughput studies. The workflow utilizes modified ARTIC network v3 primers for SARS-CoV-2 whole genome amplification. NGS libraries were prepared by a 2-step PCR method, similar to a previously reported tailed PCR method, with further optimizations to improve amplicon balance, to minimize amplicon dropout for viral genomes harboring primer-binding site mutation(s), and to integrate robotic liquid handlers. Validation studies demonstrated that the optimized workflow can process up to 2688 samples in a single sequencing run without compromising sensitivity and accuracy and with fewer amplicon dropout events compared to the standard ARTIC protocol. We additionally report results for over 65,000 SARS-CoV-2 whole genome sequences from clinical specimens collected in the United States between January and September of 2021, as part of an ongoing national genomics surveillance effort. [ABSTRACT FROM AUTHOR]

It is unclear whether the model for end-stage liver disease-sodium (MELD-Na) score captures the clinical severity of acute-on-chronic liver failure (ACLF). We compared observed 90-day mortality in patients with ACLF with expected mortality based on the calculated MELD-Na and examined the consequences of underestimating clinical severity. We identified patients with ACLF during hospitalization for cirrhosis in 127 VA hospitals between 01/01/2004 and 12/31/2014. We examined MELD-Na scores by ACLF presence and grade. We used actual and observed 90-day mortality to estimate a standardized mortality ratio (SMR) by ACLF presence and grade. We used transplant center-specific median MELD-Na at transplantation (MMaT) to estimate the proportion likely to receive priority for liver transplantation (LT) based on MELD-Na alone. Of 71,894 patients hospitalized for decompensated cirrhosis, 18,979 (26.4%) patients met the criteria for ACLF on admission. The median (P25-P75) MELD-Na on admission was 26 (22–30) for ACLF compared to 15 (12–20) for patients without ACLF; it was 24 (21–27), 27 (23–31), and 32 (26–37) for ACLF-1, 2 and 3, respectively. At 90 days, 40.0% of patients with ACLF died (30.8%, 41.6% and 68.8% with ACLF-1, 2 and 3, respectively) compared to 21.3% of patients without ACLF. Compared to the expected death rate based on MELD-Na, mortality risk was higher for patients with ACLF, SMR (95% CI): 1.52 (1.48–1.52), 1.46 (1.41–1.51), 1.50 (1.44–1.55), 1.66 (1.58–1.74) for overall ACLF, ACLF-1, -2 and -3, respectively. Only 9.1% of patients with ACLF reached the national median MELD-Na of 35 and between 17.3% to 35.1% exceeded the MMaT at any center. During index admission, 589 (0.8%) patients with ACLF were considered for LT evaluation and 16 (0.1%) were listed for LT. In a US cohort of hospitalized patients with decompensated cirrhosis, MELD-Na did not capture 90-day mortality risk in patients with ACLF. Patients with ACLF are at a disadvantage in the current MELD-Na-based system. Acute-on-chronic liver failure (ACLF) is a condition marked by multiple organ failures in patients with cirrhosis and is associated with a high risk of death. Liver transplantation may be the only curative treatment for these patients. A score called model for end-stage liver disease-sodium (MELD-Na) helps guide donor liver allocation for transplantation in the United States. The higher the MELD-Na score in a patient, the more likely that a patient receives a liver transplant. Our study data showed that MELD-Na score underestimates the risk of dying at 90 days in patients with ACLF. Thus, physicians need to start liver transplant evaluation early instead of waiting for a high MELD-Na number. • MELD-Na underestimates the 90-day mortality risk in patients with ACLF, particularly in those with MELD-Na less than 30. • Compared to other ACLF studies, this study's cohort is not restricted to waitlisted patients. • This is the first study of a large and geographically diverse population of patients with ACLF seen in routine clinical practice. • We suggest initiating early discussions about liver transplant for patients with ACLF, regardless of their MELD-Na score. [ABSTRACT FROM AUTHOR]

Background: Acid-suppressant medications, including proton pump inhibitors (PPIs) and H2 receptor antagonists (H2RAs), are frequently prescribed and have been linked to increased risk of some gastrointestinal cancers.Aims: We examined whether post-diagnosis use of PPIs/H2RAs is associated with the risk of mortality in gastrointestinal cancer patients.Methods: We used data from patients with esophageal cancer, gastric cancer, or hepatocellular carcinomas (HCCs) in the national VA Central Cancer Registry diagnosed between 2002 and 2016. We identified PPI/H2RA prescriptions that were filled before and after cancer diagnosis and used time-dependent Cox regression models to calculate adjusted hazard ratios (HRs) and 95% CIs for mortality risk. We used a time-varying exposure to avoid immortal-time bias and a 3-month lag to reduce reverse causation. A sensitivity analysis was conducted varying the lag duration between the date of cancer diagnosis and the start of follow-up.Results: PPIs were used by the majority (54% post-diagnosis use) of patients. We found no association between post-diagnosis PPI use and cancer-specific mortality in esophageal adenocarcinoma (HR 0.93; 95% CI 0.84-1.02), esophageal squamous cell carcinoma (HR 0.99; 95% CI 0.87-1.12), or gastric cardia cancer (HR 1.04; 95% CI 0.89-1.22) patients. Post-diagnosis PPI use was, however, associated with the increased risk of cancer-specific mortality for patients with gastric non-cardia cancer (HR 1.50; 95% CI 1.29-1.74) and HCC (HR 1.31; 95% CI 1.23-1.40). The results were similar for associations with post-diagnosis use of H2RAs. There was no association with pre-diagnosis PPI/H2RA use.Conclusion: Post-diagnosis PPI/H2RA use was associated with the increased mortality in gastric non-cardia cancer and HCC patients. [ABSTRACT FROM AUTHOR]

Rationale: Gelsemium elegans Benth. belongs to the family Loganiaceae and is widely distributed in northern America, east Asia, and southeast Asia. It has attracted wide attention for its diverse biological effects and complex architectures. Gelsevirine is one of the major components in G. elegans. Compared with other alkaloids from G. elegans, gelsevirine exhibits equally potent anxiolytic effects but with less toxicity. However, the metabolism of gelsevirine has not been clearly elucidated. Methods: The metabolism of gelsevirine was investigated using liver S9 fractions derived from rat liver homogenates by centrifugation at 9000 g. A rapid and accurate high‐performance liquid chromatography/quadrupole‐time‐of‐flight mass spectrometry (HPLC/QqTOF‐MS) method was applied to characterize the gelsevirine metabolites. Results: We discovered a total number of four metabolites of gelsevirine. The metabolic pathways of gelsevirine consisted of hydrogenation, N‐demethylenation and oxidation in rat liver S9. Conclusions: This is the first study on the metabolism of gelsevirine. We proposed possible metabolic pathways of gelsevirine. These findings may warrant future studies of the in vivo metabolism of gelsemine in animals. [ABSTRACT FROM AUTHOR]

The past seventeen years have witnessed tremendous progress on the experimental and theoretical explorations of the multiquark states. The hidden-charm and hidden-bottom multiquark systems were reviewed extensively in Ref. [1]. In this article, we shall update the experimental and theoretical efforts on the hidden heavy flavor multiquark systems in the past three years. Especially the LHCb collaboration not only confirmed the existence of the hidden-charm pentaquarks but also provided strong evidence of the molecular picture. Besides the well-known X Y Z and P c states, we shall discuss more interesting tetraquark and pentaquark systems either with one, two, three or even four heavy quarks. Some very intriguing states include the fully heavy exotic tetraquark states Q Q Q ̄ Q ̄ and doubly heavy tetraquark states Q Q q ̄ q ̄ , where Q is a heavy quark. The Q Q Q ̄ Q ̄ states may be produced at LHC while the Q Q q ̄ q ̄ system may be searched for at BelleII and LHCb. Moreover, we shall pay special attention to various theoretical schemes such as the chromomagnetic interaction (CMI), constituent quark model, meson exchange model, heavy quark and heavy diquark symmetry, QCD sum rules, Faddeev equation for the three body systems, Skyrme model and the chiral quark-soliton model, and the lattice QCD simulations. We shall emphasize the model-independent predictions of various models which are truly/closely related to Quantum Chromodynamics (QCD). For example, the chromomagnetic interaction arises from the gluon exchange which is fundamental and universal in QCD and responsible for the mixing and mass splitting of the conventional mesons and baryons within the same multiplet. The same CMI mechanism shall also be responsible for the mixing of the different color configurations and mass splittings within the multiplets in the multiquark sector. There have also accumulated many lattice QCD simulations through multiple channel scattering on the lattice in recent years, which provide deep insights into the underlying structure/dynamics of the X Y Z states. In terms of the recent P c states, the lattice simulations of the charmed baryon and anti-charmed meson scattering are badly needed. We shall also discuss some important states which may be searched for at BESIII, BelleII and LHCb in the coming years. [ABSTRACT FROM AUTHOR]

Background: Efforts to reduce mortality from esophageal adenocarcinoma (EA) have focused on screening and surveillance of Barrett's esophagus (BE).Aims: We sought to determine the frequency of prior diagnosis of BE in patients with EA and to evaluate the impact of a prior BE diagnosis on mortality in EA patients.Methods: This was a retrospective cohort study of patients diagnosed with EA in the VA during 2002-2016. We compared the distributions of EA stage and receipt of treatment between EA patients with and without a prior BE diagnosis and used Cox proportional hazards models to compare mortality risk (all-cause and cancer specific) unadjusted and adjusted for stage and treatment to assess their impact on any survival differences.Results: Among 8564 EA patients, only 4.9% had a prior BE diagnosis. The proportion with prior BE diagnosis increased from 3.2% in EA patients diagnosed during 2005-2007 to 7.0% in those diagnosed during 2014-2016. EA patients with a prior BE diagnosis were more likely to have stage 1 disease and receive any treatment. A prior BE diagnosis was associated with lower all-cause mortality risk (hazard ratio [HR] unadjusted for stage, 0.69; 95% CI, 0.61-0.80), which was largely explained by the earlier stage of EA at the time of diagnosis (HR adjusted for stage, 0.87; 95% CI, 0.75-0.99). There was no evidence of lead time bias or length time bias.Conclusions: Prior diagnosis of BE was associated with better survival, largely due to earlier EA stage at diagnosis. [ABSTRACT FROM AUTHOR]

This paper describes a workflow for automating the extraction of elevation-derived stream lines using open source tools with parallel computing support and testing the effectiveness of procedures in various terrain conditions within the conterminous United States. Drainage networks are extracted from the US Geological Survey 1/3 arc-second 3D Elevation Program elevation data having a nominal cell size of 10 m. This research demonstrates the utility of open source tools with parallel computing support for extracting connected drainage network patterns and handling depressions in 30 subbasins distributed across humid, dry, and transitional climate regions and in terrain conditions exhibiting a range of slopes. Special attention is given to low-slope terrain, where network connectivity is preserved by generating synthetic stream channels through lake and waterbody polygons. Conflation analysis compares the extracted streams with a 1:24,000-scale National Hydrography Dataset flowline network and shows that similarities are greatest for second- and higher-order tributaries. [ABSTRACT FROM AUTHOR]

This paper forecasts the 2016 canine Anaplasma spp. seroprevalence in the United States from eight climate, geographic and societal factors. The forecast’s construction and an assessment of its performance are described. The forecast is based on a spatial-temporal conditional autoregressive model fitted to over 11 million Anaplasma spp. seroprevalence test results for dogs conducted in the 48 contiguous United States during 2011–2015. The forecast uses county-level data on eight predictive factors, including annual temperature, precipitation, relative humidity, county elevation, forestation coverage, surface water coverage, population density and median household income. Non-static factors are extrapolated into the forthcoming year with various statistical methods. The fitted model and factor extrapolations are used to estimate next year’s regional prevalence. The correlation between the observed and model-estimated county-by-county Anaplasma spp. seroprevalence for the five-year period 2011–2015 is 0.902, demonstrating reasonable model accuracy. The weighted correlation (accounting for different sample sizes) between 2015 observed and forecasted county-by-county Anaplasma spp. seroprevalence is 0.987, exhibiting that the proposed approach can be used to accurately forecast Anaplasma spp. seroprevalence. The forecast presented herein can a priori alert veterinarians to areas expected to see Anaplasma spp. seroprevalence beyond the accepted endemic range. The proposed methods may prove useful for forecasting other diseases. [ABSTRACT FROM AUTHOR]

Using a sample of US bank mergers from 1995 to 2012, we observe that the pre-post merger changes in CEO bonus are significantly negatively related to the strength of corporate governance within the bidding bank. This suggests that bonus compensation is not consistent with the 'optimal contracting hypothesis'. Salary changes, on the other hand, are not affected by corporate governance which is in line with 'optimal contracting'. We also find that good governance is associated with more accretive deals for the bidder. Overall, our results are consistent with the notion that, unlike salary and long-term compensation, bonus compensation is not aligned with value creation and is more vulnerable to CEO manipulation in banks with poor corporate governance. Copyright © 2016 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

A number of epidemiological studies have explored the association between lycopene or lycopene-rich food intake and the risk of colorectal cancer, but the results of these studies have not been consistent. We conducted a systematic review and meta-analysis of studies published in the PubMed and EMBASE databases to quantitatively assess the association between lycopene consumption and the risk of colorectal cancer. A total of 15 studies were included in the meta-analysis, and the summary relative risk (RR) for highest versus lowest category indicated no significant association between lycopene consumption and the risk of colorectal cancer [RR = 0.94, 95% confidence interval (CI): 0.80–1.10]. However, a significant inverse association was observed between lycopene consumption and the site of cancer in the colon (RR = 0.88, 95% CI: 0.81–0.96). We also found that the incidence of colon cancer and lycopene intake did not exhibit dose-response relationships. The Grades of Recommendations Assessment, Development and Evaluation (GRADE) quality in our study was very low. In conclusion, this meta-analysis indicates that lycopene consumption is not associated with the risk of colorectal cancer. Further research will be needed in this area to provide conclusive evidence. [ABSTRACT FROM AUTHOR]

Background Poor diet quality in childhood and adolescence is associated with adverse health outcomes throughout life, yet the dietary habits of American children and how they change across childhood and adolescence are unknown. Objectives This study sought to describe diet quality among children and adolescents by assessing adherence to the 2010 Dietary Guidelines for Americans (DGA) and to determine whether any differences in adherence occurred across childhood. Design, setting, and participants We employed a cross-sectional design using data from the National Health and Nutrition Examination Survey (NHANES). Of 9,280 children aged 4 to 18 years who participated in NHANES from 2005 to 2010, those with insufficient data on dietary recall (n=852) or who were pregnant or lactating during the time of interview (n=38) were excluded from the final study sample (n=8,390). Main outcome measures We measured adherence to the DGA using the Healthy Eating Index 2010 (HEI-2010) and stratified participants into three age groups (4 to 8, 9 to 13, and 14 to 18 years of age). We analyzed each of 12 HEI-2010 components and total HEI-2010 score. Results The youngest children had the highest overall diet quality due to significantly greater scores for total fruit, whole fruit, dairy, and whole grains. These children also had the highest scores for sodium, refined grains, and empty calories. Total HEI-2010 scores ranged from 43.59 to 52.11 out of 100, much lower than the minimum score of 80 that is thought to indicate a diet associated with good health. Conclusions Overall, children and adolescents are failing to meet the DGA and may be at an increased risk of chronic diseases throughout life. By analyzing which food groups show differences between age groups, we provide data that can inform the development of dietary interventions to promote specific food groups targeting specific ages and improve diet quality among children and adolescents. [ABSTRACT FROM AUTHOR]

Many different crop species were selected for a common suite of 'domestication traits', which facilitates their use for studies of parallel evolution. Within domesticated rice ( Oryza sativa), there has also been independent evolution of weedy strains from different cultivated varieties. This makes it possible to examine the genetic basis of parallel weed evolution and the extent to which this process occurs through shared genetic mechanisms. We performed comparative QTL mapping of weediness traits using two recombinant inbred line populations derived from crosses between an indica crop variety and representatives of each of the two independently evolved weed strains found in US rice fields, strawhull (S) and blackhull awned (B). Genotyping-by-sequencing provided dense marker coverage for linkage map construction (average marker interval <0.25 cM), with 6016 and 13 730 SNPs mapped in F5 lines of the S and B populations, respectively. For some weediness traits (awn length, hull pigmentation and pericarp pigmentation), QTL mapping and sequencing of underlying candidate genes confirmed that trait variation was largely attributable to individual loci. However, for more complex quantitative traits (including heading date, panicle length and seed shattering), we found multiple QTL, with little evidence of shared genetic bases between the S and B populations or across previous studies of weedy rice. Candidate gene sequencing revealed causal genetic bases for 8 of 27 total mapped QTL. Together these findings suggest that despite the genetic bottleneck that occurred during rice domestication, there is ample genetic variation in this crop to allow agricultural weed evolution through multiple genetic mechanisms. [ABSTRACT FROM AUTHOR]

Epidemiological and other evidence suggests that vitamin D may be protective against several chronic diseases. Assessing vitamin D status in epidemiological studies, however, is challenging given finite resources and limitations of commonly used approaches. Using multivariable linear regression, we derived predicted 25-hydroxyvitamin D (25(OH)D) scores based on known determinants of circulating 25(OH)D, including age, race, UV-B radiation flux at residence, dietary and supplementary vitamin D intakes, BMI, physical activity, alcohol intake, post-menopausal hormone use (women only) and season of blood draw, in three nationwide cohorts: the Nurses' Health Study, Nurses' Health Study II and the Health Professionals Follow-up Study. The model r2 for each cohort ranged from 0·25 to 0·33. We validated the prediction models in independent samples of participants from these studies. Mean measured 25(OH)D levels rose with increasing decile of predicted 25(OH)D score, such that the differences in mean measured 25(OH)D between the extreme deciles of predicted 25(OH)D were in the range 8·7–12·3 ng/ml. Substituting predicted 25(OH)D scores for measured 25(OH)D in a previously published case–control analysis of colorectal cancer yielded similar effect estimates with OR of approximately 0·8 for a 10 ng/ml difference in either plasma or predicted 25(OH)D. We conclude that these data provide reasonable evidence that a predicted 25(OH)D score is an acceptable marker for ranking individuals by long-term vitamin D status and may be particularly useful in research settings where biomarkers are not available for the majority of a study population. [ABSTRACT FROM PUBLISHER]

Background: Growing evidence indicates that depression is more common in people who partake in a pro-inflammatory diet. The objective of our study was to assess the association between the Dietary Inflammatory Index (DII) and depression through a cross-sectional study of the National Health and Nutrition Examination Survey from 2007 to 2018.Methods: We used weighted multivariable logistic regression models with subgroup analysis to explore the relationship between DII and depression. Generalized additive models were used to test whether there was a nonlinear association. Then, we constructed a two-piece linear regression model and performed a recursive algorithm to calculate the inflection point.Results: The study enrolled a total of 30,627 individuals from the United States. In the regression model with full confounding variables adjusted, the OR (95 % CI) for the association between DII and depression was 1.05 (1.04, 1.06). A J-shaped association was found between DII and depression, with a turning point of 2.74. After the turning point, the OR (95 % CI) was 1.60 (1.51, 1.69). Only the interaction in the cardiovascular disease (CVD) analysis was statistically significant.Conclusion: Our study highlighted a J-shaped association between DII and depression in a nationally representative sample of adults from the United States. [ABSTRACT FROM AUTHOR]

Objectives. We used 2 approaches based on published information to compare the impacts on leukemia incidence and benzene exposure of the 1990 US Clean Air Act (CAA) amendments and smoking prevention and cessation efforts. Methods. We extrapolated leukemia mortality related to community air pollution levels and to cigarette smoking from data from the US Environmental Protection Agency and the US Surgeon General. We also estimated relative decline in total exposures to benzene (a known human leukemogen) owing to the CAA amendments and to smoking prevention and cessation efforts. Results. We estimated that because of the CAA, there will be approximately 300 fewer leukemia deaths in the United States during the period 2000 through 2020. During the closest comparable period (1987-2007), we estimated that decline in cigarette smoking led to 7120 fewer leukemia deaths, of which 1282 to 3702 were attributable to benzene. Similarly, the decline in smoking led to about a tenfold greater decrease in total-population benzene exposure than did the 1990 CAA amendments. Conclusions. Both the CAA and smoking cessation activities contribute to a decrease in leukemia incidence. Smoking cessation activities have had a greater effect in the past. [ABSTRACT FROM AUTHOR]

• Proposing an interpretable utility-based framework for dynamic activity pattern estimation. • Mapping from individual trip chains to aggregated activity location types. • Estimating traveler behavior with the support of multiple data sources. • Integrating machine learning tools, nested logit model and transportation domain knowledge. • Testing the proposed framework using 2017 national household survey and Google mobility dataset. During the coronavirus disease 2019 pandemic, the activity engagement and travel behavior of city residents have been impacted by government restrictions, such as temporary city-wide lockdowns, the closure of public areas and public transport suspension. Based on multiple heterogeneous data sources, which include aggregated mobility change reports and household survey data, this paper proposes a machine learning approach for dynamic activity chain pattern estimation with improved interpretability for examining behavioral pattern adjustments. Based on historical household survey samples, we first establish a computational graph-based discrete choice model to estimate the baseline travel tour parameters before the pandemic. To further capture structural deviations of activity chain patterns from day-by-day time series, we define the activity-oriented deviation parameters within an interpretable utility-based nested logit model framework, which are further estimated through a constrained optimization problem. By incorporating the long short-term memory method as the explainable module to capture the complex periodic and trend information before and after interventions, we predict day-to-day activity chain patterns with more accuracy. The performance of our model is examined based on publicly available datasets such as the 2017 National Household Travel Survey in the United States and the Google Global Mobility Dataset throughout the epidemic period. Our model could shed more light on transportation planning, policy adaptation and management decisions during the pandemic and post-pandemic phases. [ABSTRACT FROM AUTHOR]

Multiple sectors within U.S. crop industries—growers, elevators, handlers/shell- ers, processors, distributors, and consumers—are affected by aflatoxin contamination of commodities, and have the potential to control it using methods developed at both the pre- and postharvest levels. While methods exist, adoption is low; thus, we seek to investigate ways to increase adoption. We believe there are at least three ways to improve adoption of existing aflatoxin control techniques: (1) providing economic incentives; (2) proving and or improving cost-effectiveness of the control methods; and (3) education/outreach across all the relevant industry sectors. Frequently within a commodity there is a mismatch in economic incentives, such that different sectors bear the brunt of aflatoxin costs at disproportionate rates. For example, corn and cottonseed growers bear most of the cost for aflatoxin control, whereas in peanuts and tree nuts, shellers and handlers incur the costs of aflatoxin control. Thus, peanut and tree nut growers may have no economic incentive to apply preharvest aflatoxin control. Postharvest control options are limited and in many cases are not yet approved by the EPA or FDA. The Kaldor-Hicks efficiency criterion may help to resolve this economic dilemma. If this criterion was to be applied to aflatoxin control in peanut and tree nuts, growers could be compensated by shellers/handlers to adopt preharvest aflatoxin control methods. However, the control methods must be cost-effective for this compensatory arrangement to work. We present three case studies of cost-effectiveness to reduce aflatoxin contamination in different crops: AF36 in cottonseed, Bt in corn, and Afla-Guard in peanuts. [ABSTRACT FROM AUTHOR]

Summary: In recent years, geospatial data have exploded to massive volume and diversity and subsequently cause serious usability issues for researchers in various scientific areas. This paper describes a cyberGIS community data service framework to facilitate geospatial big data access, processing, and sharing based on a hybrid supercomputer architecture. Specifically, the framework aims to enhance the usability of national elevation dataset released by the U.S. Geological Survey in the contiguous United States at the resolution of 1/3 arc‐second. A community data service, namely TopoLens, is created to demonstrate the workflow integration of national elevation dataset and the associated computation and analysis. Two user‐friendly environments, including a publicly available web application and a private workspace based on the Jupyter notebook, are provided for users to access both precomputed and on‐demand computed high‐resolution elevation data. The system architecture of TopoLens is implemented by exploiting the ROGER supercomputer, the first cyberGIS supercomputer dedicated to geospatial problem‐solving. The usability of TopoLens has been acknowledged in the topographic user community evaluation. [ABSTRACT FROM AUTHOR]

Cedrol is an extremely versatile sesquiterpene alcohol that was approved by the Food and Drug Administration of the United States as a flavoring agent or adjuvant and has been commonly used as a flavoring ingredient in cosmetics, foods and medicine. Furthermore, cedrol possesses a wide range of pharmacological properties including sedative, anti-inflammatory and cytotoxic activities. Commercial production of cedrol relies on fractional distillation of cedar wood oils, followed by recrystallization, and little has been reported about its biosynthesis and aspects of synthetic biology. Here, we report the cloning and functional characterization of a cedrol synthase gene (Lc-CedS) from the transcriptome of the glandular trichomes of a woody Lamiaceae plant Leucosceptrum canum. The recombinant Lc-CedS protein catalyzed the in vitro conversion of farnesyl diphosphate into the single product cedrol, suggesting that Lc-CedS is a high-fidelity terpene synthase. Co-expression of Lc-CedS , a farnesyl diphosphate synthase gene and seven genes of the mevalonate (MVA) pathway responsible for converting acetyl-CoA into farnesyl diphosphate in Escherichia coli afforded 363 μg/L cedrol as the sole product under shaking flask conditions. Transient expression of Lc-CedS in Nicotiana benthamiana also resulted in a single product cedrol with a production level of 3.6 μg/g fresh weight. The sole production of cedrol by introducing of Lc-CedS in engineered E. coli and N. benthamiana suggests now alternative production systems using synthetic biology approaches that would better address sufficient supply of cedrol. A sesquiterpene cyclase for sole production of cedrol using synthetic biology approaches. Image 1 • A high-fidelity cedrol synthase was cloned and identified from Leucosceptrum canum. • Escherichia coli harboring Lc-CedS produced 363 μg/L cedrol as a single product. • Nicotiana benthamiana expressing Lc-CedS produced cedrol with a yield of 3.6 μg/g FW. [ABSTRACT FROM AUTHOR]

Global health has stimulated a lot of students and has attracted the interest of many faculties, thereby initiating the establishment of many academic programs on global health research and education. global health education reflects the increasing attention toward social accountability in medical education. This study aims to identify gaps in the studies on global health education. A critical literature review of empirical studies was conducted using Boolean search techniques. A total of 238 articles, including 16 reviews, were identified. There had been a boom in the numbers of studies on global health education since 2010. Four gaps were summarized. First, 94.6% of all studies on global health education were conducted in North American and European countries, of which 65.6% were carried out in the United States, followed by Canada (14.3%) and the United Kingdom (9.2%). Only seven studies (2.9%) were conducted in Asian countries, five (2.1%) in Oceania, and two (0.8%) in South American/Caribbean countries. A total of 154 studies (64.4%) were qualitative studies and 64 studies (26.8%) were quantitative studies. Second, elective courses and training or programs were the most frequently used approach for global health education. Third, there was a gap in the standardization of global health education. Finally, it was mainly targeted at medical students, residents, and doctors. It had not granted the demands for global health education of all students majoring in medicine-related studies. Global health education would be a potentially influential tool for achieving health equity, reducing health disparities, and also for future professional careers. It is the time to build and expand education in global health, especially among developing countries. Global health education should be integrated into primary medical education. Interdisciplinary approaches and interprofessional collaboration were recommended. Collaboration and support from developed countries in global health education should be advocated to narrow the gap and to create further mutual benefits. [ABSTRACT FROM AUTHOR]

Abstract: Background: Despite the key role that women from limited income families play as family food providers and their high risk for diet-related chronic diseases, there is a paucity of data about their diet quality and how it might vary by race/ethnicity. Objective: To compare nutrient and food intakes of multiethnic mothers with children in Head Start from Texas and Alabama. Design: Cross-sectional, secondary data analysis. Methods: The sample was 603 mothers, 33% Hispanic American from Texas; 19% African American from Texas; 24% African American from Alabama; and 24% white from Alabama who were interviewed from fall 2004 to spring 2005. Diet quality was evaluated by averaging 24-hour dietary recalls from 3 nonconsecutive days and calculating the percent meeting the Estimated Average Requirement, the Dietary Guidelines for fat and added sugar, and the mean adequacy ratio for eight nutrients. For multiple comparisons, the least square means statement was used for general linear model procedures, adjusted for age, body mass index, and energy intake. Results: The average mean adequacy ratio scores for diet quality were low overall, but 44% of Hispanic Americans had mean adequacy ratio scores <85, whereas 96% to 97% of other groups did. Most mothers exceeded 35% of energy from fat, with Hispanic Americans having the lowest percentage. Overall, 15% of mothers exceeded 25% of energy from added sugars, with Hispanic Americans having 5% with excess intakes. Energy intakes were highest for Hispanic Americans (2,017 kcal) and lowest for African Americans (1,340 kcal). The Hispanic Americans surveyed averaged 4.6 c fruit and vegetables per day compared to 3.2, 2.3, and 2.9 c/day among African Americans from Texas, African Americans from Alabama, and whites from Alabama, respectively. Conclusions: Despite limited food resources, Hispanic-American mothers consumed adequate amounts of fruit and vegetables. There was considerable variation in diet quality among race/ethnic groups on a low income budget. [Copyright &y& Elsevier]

Background: In the United States, the lifetime prevalence of depression in the US population is 20.6 %. We aimed to understand the temporal trends in the prevalence of depression among adults in the United States during the period 2013-2022 as well as the effects of age, period, and cohort effects on the prevalence of depression., Methods: Data from 3,139,488 participants in the U.S. Behavioral Risk Factor Surveillance System (BRFSS) from 2013 to 2022 were used in this study. The joinpoint regression model was used to calculate annual percentage change (APC) and average annual percentage change (AAPC) to learn about the time trends in the prevalence of depression. Age-period-cohort models were used to estimate the effects of age, period, and birth cohort effects on the prevalence of depression., Results: The prevalence of depression among adults in the United States showed an overall increasing trend from 2013 to 2022. The rate of increase was greater in males than females, with AAPC values of 1.44 % (95 % CI: 0.32-2.18), and 1.23 % (95 % CI: 0.32-2.25), respectively. Regarding the age effect, the risk of depression among adults in the United States generally showed an increasing and then decreasing trend with age. The risk of developing the condition reached its maximum at 50-54 years (RR = 1.28, 95 % CI = 1.26-1.30). Regarding the period effect, the risk of depression among US adults was higher during 2018-2022 than during 2013-2017. The overall cohort effect for depression prevalence was a higher risk for those born later, with a maximum RR of 1.51 (95 % CI: 1.47-1.54)., Conclusion: The prevalence of adult depression in the United States is showing an increasing trend. Middle-aged people and those born later in life deserve more attention as high-risk groups. It is recommended that the condition burden of depression be reduced with the promotion of healthy lifestyles, the promotion of interpersonal communication, as well as enhanced mental health education and mental health literacy., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Targeting Meis1 and Hoxb13 transcriptional activity could be a viable therapeutic strategy for heart regeneration. In this study, we performd an in silico screening to identify FDA-approved drugs that can inhibit Meis1 and Hoxb13 transcriptional activity based on the resolved crystal structure of Meis1 and Hoxb13 bound to DNA. Paromomycin (Paro) and neomycin (Neo) induced proliferation of neonatal rat ventricular myocytes in vitro and displayed dose-dependent inhibition of Meis1 and Hoxb13 transcriptional activity by luciferase assay and disruption of DNA binding by electromobility shift assay. X-ray crystal structure revealed that both Paro and Neo bind to Meis1 near the Hoxb13-interacting domain. Administration of Paro-Neo combination in adult mice and in pigs after cardiac ischemia/reperfusion injury induced cardiomyocyte proliferation, improved left ventricular systolic function and decreased scar formation. Collectively, we identified FDA-approved drugs with therapeutic potential for induction of heart regeneration in mammals., Competing Interests: Competing interests M.G. is founder, consultant, member of the board and equity holder in Forcefield Therapeutics, Heqet Therapeutics and Purespring Therapeutics. All other authors declare no competing interests.

Introduction: There are limited longitudinal data on the cost of treating patients with cirrhosis, which hampers value-based improvement initiatives., Methods: We conducted a retrospective cohort study of patients with cirrhosis seen in the Veterans Affairs health care system from 2011 to 2015. Patients were followed up through 2019. We identified a sex-matched and age-matched control cohort without cirrhosis. We estimated incremental annual health care costs attributable to cirrhosis for 4 years overall and in subgroups based on severity (compensated, decompensated), cirrhosis complications (ascites, encephalopathy, varices, hepatocellular cancer, acute kidney injury), and comorbidity (Deyo index)., Results: We compared 39,361 patients with cirrhosis with 138,964 controls. The incremental adjusted costs for caring of patients with cirrhosis were $35,029 (95% confidence interval $32,473-$37,585) during the first year and ranged from $14,216 to $17,629 in the subsequent 3 years. Cirrhosis complications accounted for most of these costs. Costs of managing patients with hepatic encephalopathy (year 1 cost, $50,080) or ascites ($50,364) were higher than the costs of managing patients with varices ($20,488) or hepatocellular cancer ($37,639) in the first year. Patients with acute kidney injury or those who had multimorbidity were the most costly at $64,413 and $66,653 in the first year, respectively., Discussion: Patients with cirrhosis had substantially higher health care costs than matched controls and multimorbid patients had even higher costs. Cirrhosis complications accounted for most of the excess cost, so preventing complications has the largest potential for cost saving and could serve as targets for improvement., (Copyright © 2023 by The American College of Gastroenterology.)

Objectives: Among patients with pancreatic cancer, studies show racial disparities at multiple steps of the cancer care pathway. Access to healthcare is a frequently cited cause of these disparities. It remains unclear if racial disparities exist in an integrated, equal access public system such as the Veterans Affairs healthcare system., Methods: We identified all patients diagnosed with pancreatic adenocarcinoma in the national Veterans Affairs Central Cancer Registry from January 2010 to December 2018. We examined the independent association between race and 3 endpoints: stage at diagnosis, receipt of treatment, and survival while adjusting for sociodemographic factors and medical comorbidities., Results: We identified 8529 patients with pancreatic adenocarcinoma, of whom 79.5% were White and 20.5% were Black. Black patients were 19% more likely to have late-stage disease and 25% less likely to undergo surgical resection. Black patients had 13% higher mortality risk compared with White patients after adjusting for sociodemographic characteristics and medical comorbidities. This difference in mortality was no longer statistically significant after additionally adjusting for cancer stage and receipt of potentially curative treatment., Conclusions: Equal access to healthcare might have reduced but failed to eliminate disparities. Dedicated efforts are needed to understand reasons underlying these disparities in an attempt to close these persistent gaps., Competing Interests: Disclosure: The authors declare no conflict of interest., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Drug-associated kidney injury is related to longer hospitalization and increased risk of chronic kidney disease and mortality. However, there is currently a lack of large population studies on drug-associated kidney injury in children. This study aimed to study perform data mining to generate hypotheses on drugs, which may deserve to be assessed as per their potential risk of increasing kidney injury in children. We extracted and analyzed reports on drugs associated with kidney injury in children in the FDA Adverse Event Reporting System (FAERS). We conducted a disproportionality analysis using proportional reporting ratio (PRR) to evaluate the association between drugs and kidney injury in children. Meanwhile, comparisons were performed with drug labels to identify drugs that, despite not having kidney injury currently mentioned in their labels, may potentially be associated with risks of kidney injury in children. A total of 6347 children had drug-associated kidney injury in the FAERS database. The top five drugs with the highest PRR were gentamicin (PRR = 12.28, N = 157 cases, Chi-Squared = 1602.77), piperacillin-tazobactam (PRR = 9.77, N = 129 cases, Chi-Squared = 1003.24), amlodipine (PRR = 8.98, N = 271 cases, Chi-Squared = 1861.46), vancomycin (PRR = 8.91, N = 295 cases, Chi-Squared = 1998.64), and ceftriaxone (PRR = 8.00, N = 251 cases, Chi-Squared = 1494.02). According to drug labels, 9 drugs (9/30) were classified as potential nephrotoxins., Conclusions: Approximately one-third of drugs associated with kidney injury in children do not list kidney injury as a side effect in their drug labels. Future studies are therefore warranted to evaluate whether these drugs are associated with such a risk., What Is Known: • Nephrotoxic drugs are an increasingly common cause of acute kidney injury in hospitalized children. • Currently, no study has systematically combed drugs associated with kidney injury in children., What Is New: • Approximately a third of drugs showing signals for potential kidney injury in children in data mining do not mention this side effect in their drug labels. • This study provides data on drugs needing further study to determine whether they might increase the risk of kidney injury in children., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background: In 2018, Nevada implemented opioid prescribing legislation (AB474) to support the uptake of CDC pain care guidelines. We studied the law's association with doses over threshold levels of morphine milligram equivalents (MMEs) and with time to dose increases and decreases, among long-term opioid patients., Methods: A difference-in-difference study examined dosing changes across opioid prescription episodes (ie, prescriptions within 30 day and within the same dosing threshold). Patients with at least 120 days supply over 6 months in Nevada and Colorado Medicaid pharmacy claims were included. Using a logistic regression model, we compare the predicted probabilities that opioid episodes exceeded 50 MME before and after implementation of the law, in both states. Adjusted hazard ratios (aHR) from a gap time survival model estimated time to escalate above 50 MME among low-dose episodes (<50 MME), and time to de-escalate below 50 MME among high-dose episodes (≥50 MME)., Results: Among 453,577 episodes (74,292 patients), the Nevada law was associated with a 2.9% reduction in prescriptions over 50 MME (95% CI: -3.5, -2.3) compared with Colorado. While the law was also associated with slower escalation (Nevada: aHR = 0.75; 95% CI: 0.72, 0.77, Colorado: aHR = 1.04; 95% CI: 1.01, 1.06), it was also associated with slower de-escalation (Nevada: aHR = 0.87; 95% CI: 0.84, 0.89, Colorado: aHR = 0.97; 95% CI: 0.96, 0.99)., Conclusions: Slower dose escalations, rather than faster dose de-escalation, likely explain post-law reductions in doses over 50 MME. Slower dose de-escalations may be due to longer days supply post-policy., Competing Interests: The authors declare no conflict of interest., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Evidence of drug-induced liver injury is abundant in adults but is lacking in children. Our aim was to identify suspected drug signals associated with pediatric liver injury., Methods: Hepatic adverse events (HAEs) among children reported in the Food and Drug Administration Adverse Event Reporting System were analyzed. A descriptive analysis was performed to summarize pediatric HAEs, and a disproportionality analysis was conducted by evaluating reporting odds ratios (RORs) and proportional reporting ratios to detect suspected drugs., Results: Here, 14,143 pediatric cases were reported, specifically 49.6% in males, 45.1% in females, and 5.2% unknown. Most patients (68.8%) were 6-18 years old. Hospitalization ranked first among definite outcomes (7,207 cases, 37.2%). In total, 264 disproportionate drug signals were identified. The top 10 drugs by the number of reports were paracetamol (1,365; ROR, 3.6; 95% confidence interval (CI), 3.4-3.8), methotrexate (878; ROR, 2.5; 95% CI, 2.3-2.7), vincristine (649; ROR, 3.0; 95% CI, 2.8-3.3), valproic acid (511; ROR, 3.2; 95% CI, 2.9-3.6), cyclophosphamide (490; ROR, 2.4; 95% CI, 2.2-2.6), tacrolimus (427; ROR, 2.4; 95% CI, 2.2-2.7), prednisone (416; ROR, 2.1; 95% CI, 1.9-2.3), prednisolone (401; ROR, 2.3; 95% CI, 2.1-2.5), etoposide (378; ROR, 2.3; 95% CI, 2.1-2.6), and cytarabine (344; ROR, 2.8; 95% CI, 2.5-3.2). After excluding validated hepatotoxic drugs, six were newly detected, specifically acetylcysteine, thiopental, temazepam, nefopam, primaquine, and pyrimethamine., Conclusions: The hepatotoxic risk associated with 264 signals needs to be noted in practice. The causality of hepatotoxicity and mechanism among new signals should be verified with preclinical and clinical studies., (© 2023. BioMed Central Ltd., part of Springer Nature.)

Introduction: Due to the improved overall survival and life expectancy of older women with breast cancer, cardiovascular disease (CVD) arose as the primary cause of non-cancer-related deaths in this population. Therefore, assessing the health-related quality of life (HRQoL) of breast cancer patients with comorbid CVD is becoming increasingly vital. Our study aimed to evaluate the association between comorbid CVD and HRQoL among older women with early-stage breast cancer who are receiving adjuvant endocrine therapy (AET) in the United States., Materials and Methods: We conducted a retrospective cohort study using the 2006-2017 Surveillance, Epidemiology, and End Results-Medicare Health Outcomes Survey data. We identified female patients over the age of 65 who were diagnosed with stage I-III hormone receptor-positive breast cancer and treated with AET. HRQoL was assessed by the physical and mental component summary (PCS & MCS) in the health survey. CVD was defined as a history of acute myocardial infarction (AMI), congestive heart failure (CHF), angina, stroke, or other heart-related conditions. We performed multivariate linear regression models while controlling for covariates., Results: Among 3,904 older women, a history of CHF [β = -1.97, p = 0.025], stroke [β = -3.00, p < 0.010], or other heart-related condition [β = -1.10, p = 0.046] was significantly associated with lower PCS. However, no significant differences in PCS scores were found between women with a history of AMI or angina and those without these conditions. Having a history of CHF [β = -1.72, p = 0.033] or stroke [β = -1.48, p = 0.038] was significantly associated with lower MCS, whereas a history of angina, AMI, or other heart conditions was not associated with significant differences in MCS. Our study did not observe any significant differences in PCS and MCS between the two types AETs., Discussion: The study found that older women with early-stage breast cancer who were being treated with AETs had a lower HRQoL if they had a history of CHF or stroke. These comorbidities were identified as strong predictors for decreased HRQoL. The findings highlight the significance of managing cardiovascular diseases in such patients for better HRQoL while they receive AET treatment., Competing Interests: Declaration of Competing Interest Yi-Shao Liu: YSL is a current student assistant (co-op) at Novo Nordisk Inc. and a graduate student at the University of Texas at Austin. The work was completed without any involvement with Novo Nordisk Inc. Chanhyun Park: None. Yan Liu: None., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Being among the few last-resort antibiotics, colistin (COL) has been used to treat severe infectious diseases, such as those caused by multidrug-resistant Gram-negative bacteria (MDR GNB). However, the appearance of colistin-resistant (COL-R) GNB has been frequently reported. Therefore, novel antimicrobial strategies need to be urgently sought to address this resistance challenge. In the present study, antimicrobial drug screening conducted revealed that bithionol (BT), approved by the Food and Drug Administration and used as an anthelminthic drug for paragonimiasis, exhibited a synergistic antibacterial effect with COL. Clinically isolated COL-R GNB were used as candidates to evaluate the synergistic antibacterial activity. The results revealed that BT could significantly reverse the sensitivity of COL-R GNB to COL. Furthermore, the combined application of BT and COL can reduce bacterial biofilm formation and have a scavenging effect on the mature biofilm in vitro . The damage caused to the bacterial cell membrane integrity by the BT/COL combination was observed under a fluorescence microscope. The fluorescence intensity of reactive oxygen species also increased in the experimental group. The BT/COL combination also exhibited a synergistic antibacterial effect in vivo . Importantly, BT was confirmed to be safe at the highest concentrations that exerted synergistic effects on all tested strains. In conclusion, our findings demonstrated that BT exerted synergistic antimicrobial and anti-biofilm effects when combined with COL against MDR organisms, especially COL-R GNB, in vitro and in vivo . The findings thus provide a reference for the clinical response to the serious challenge of MDR GNB and the exploitation of the potential antibacterial activities of existing clinical non-antibacterial drugs.

Though triazole antifungals are the first choice for preventing and treating invasive fungal infections, periostitis caused by voriconazole has been described in emerging case reports; however, no studies exist on this association in real-world clinical settings. Our study aimed to identify the association between periostitis and triazole antifungals by analyzing data from the FDA Adverse Event Reporting System (FAERS). We extracted and analyzed reports on the association between periostitis and triazole antifungals in FAERS from the first quarter of 2004 to the second quarter of 2022 using OpenVigil 2.1. Disproportionality analysis was performed to evaluate the association between periostitis and triazole antifungals, and chi-squared (χ 2 ), relative reporting ratio (RRR), reporting odds ratio (ROR), proportional reporting ratio (PRR), and Bayesian confidence propagation neural networks (BCPNN) of information components (IC) were reported. In total, 143 patients experienced periostitis while using voriconazole. Disproportionality analysis identified an association between periostitis and voriconazole (χ 2  = 82,689.0, RRR = 583.6, 95%CI [472.4, 721.1], PRR = 1808.9, 95%CI [1356.0, 2412.9], ROR = 1831.7, 95%CI [1371.6, 2446.3], IC = 9.2, 95%CI [8.6, 9.8]). However, no safety signals were observed between periostitis and other triazole antifungals. When stratified by sex and age, disproportionality analysis identified positive signals between periostitis and voriconazole. The possible association between periostitis and voriconazole should attract sufficient attention in clinical practice. Alternative treatment with other triazole antifungals can be considered, and causality needs to be verified in further prospective studies., (© 2023. The Author(s).)

It was intended to study the clinical effect of Shibing Xingnao Granules on patients with vascular dementia (VD) and to explore its effect on serum neuronal apoptosis molecule levels in VD patients. For this purpose, 78 VD patients, as research objects, were grouped into a control group (acupuncture therapy) and an observation group (acupuncture therapy + Shibing Xingnao Granules) using the random number table method, with 39 cases per group. The clinical effect, cognitive function, neurological function, activity of daily living (ADL) score, and serum B-cell lymphoma-2 (Bcl-2), Bcl-2 associated X protein (Bax), as well as Caspase-3 (Casp3) levels in two groups were observed. Results showed that the markedly effective rate (MER) (82.05%) and total effective rate (TER) (100%) in the observation group were higher than the control group (56.41%, 92.31%) (P<0.05). After treatment, the Mini-mental State Examination (MMSE) score, the distributions of mild VD and normal patients, ADL score, and Bcl-2 level were higher in the observation group than in the control group. National Institutes of Health Stroke Scale (NIHSS) score, Bax, and Casp3 levels were lower in the observation group (P<0.05). The conclusion was that Shibing Xingnao Granules could further enhance the therapeutic effect of VD patients, and could increase Bcl-2 level and reduce Bax and Casp3 levels.

Introduction: The prescription opioid epidemic led to federal, state, and health system guidelines and policies aimed at mitigating opioid misuse, including presumptive urine drug testing (UDT). This study identifies whether a difference exists in UDT use among different primary care medical license types., Methods: The study used January 2017-April 2018 Nevada Medicaid pharmacy and professional claims data to examine presumptive UDTs. We examined correlations between UDTs and clinician characteristics (medical license type, urban/rural status, care setting) along with clinician-level measures of patient mix characteristics (proportions of patients with behavioral health diagnoses, early refills). Adjusted odds ratios (AORs) and predicted probabilities (PPs) from a logistic regression with a binomial distribution are reported. The analysis included 677 primary care clinicians (medical doctors [MD], physician assistants [PA], nurse practitioners [NP])., Results: Of those in the study, 85.1 % of clinicians did not order any presumptive UDTs. NPs had the highest proportion of UDT use (21.2 % of NPs), followed by PAs (20.0 % of PAs), and MDs (11.4 % of MDs). Adjusted analyses showed that being a PA or NP was associated with higher odds of UDT (PA: AOR: 3.6; 95 % CI: 3.1-4.1; NP: AOR: 2.5; 95 % CI: 2.2-2.8) compared to being an MD. PAs had the highest PP for ordering UDTs (2.1 %, 95 % CI: 0.5 %-8.4 %). Among clinicians who ordered UDTs, midlevel clinicians had higher mean and median UDT use (PA and NP mean: 24.3 % vs. MDs: 19.4 %; PA and NP median: 17.7 % vs. MDs: 12.5 %)., Conclusion: In Nevada Medicaid, UDTs are concentrated among 15 % of primary care clinicians who are frequently non-MDs. More research should include PAs and NPs when examining clinician variation in mitigating opioid misuse., Competing Interests: Declaration of competing interest The authors have no conflict of interest to report., (Published by Elsevier Inc.)

Ethnopharmacological Relevance: Licorice is a multi-purpose plant raw material, which is widely used in the pharmaceutical industry and food industry, cosmetic industry, etc. It has a wide application in various countries and regions around the world., Aim of Study: This paper studied the trade situation of licorice-related products among major countries and regions in the world, providing a practical reference for the sustainable development of the global licorice industry., Materials and Methods: The licorice trade data of licorice-related products came from the United Nations Commodity Trade Database and China Customs data. We analyzed the world's major trading countries by using international market share (IMS), trade competitiveness index (TC), average export price (AEP) and average import price (AIP), and analyzed global trade flows with chord diameter., Results: Uzbekistan, Kazakhstan and Iran mainly export licorice raw materials and low value-added products. China is both a producer and a consumer of licorice raw materials and licorice products. The processing trade of the licorice industry in China has advantages, and the structure of import and export trade has been continuously improved. The United States, France, Germany and other developed countries are still important consumers who rely on the intellectual property rights and brand advantages of licorice products, which have stronger global trade radiation capacity., Conclusions: China's trade structure has been optimized and its industrial competitiveness has been enhanced. China's experience can be used for reference by other countries, especially those with rich licorice resources among the SCO members., (Copyright © 2022 Elsevier B.V. All rights reserved.)

Objectives: This study aimed to estimate the long-term trends of deaths attributable smoking in China, Japan, the United Kingdom (UK) and the United States (US). Methods: Using 2000-2019 death data from Global Burden of Disease (GBD) 2019, we estimated age-period-cohort effects on smoking attributable mortality, and decomposed of differences in smoking-attributable deaths in 1990 and 2019 into demographic factors. Results: From 1990 to 2019, smoking-attributable deaths increased in China, which was due to population growth and demographic aging. From 1990 to 2019, both age-standardized smoking attributable mortality rates trended downward across countries. Among four countries, age rate ratios (RRs) for smoking-attributable mortality increased with age, while period and cohort RRs decreased with year. Conclusion: The age-standardized mortality rates, period effects and cohort effects of smoking attributable mortality in China, Japan, UK, and US have been declining in both sexes from 1990 to 2019, which suggests that smoke-free policies, help to quit tobacco use, improved health education, more accessible healthcare service, and increased taxes have been effective. Additionally, increased smoking attributable deaths in elderly should got more attention., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Wen, Xie, Shi, Liu, Liu and Yu.)

Chronic kidney disease (CKD) caused heavy burden globally. This study aimed to investigate the patterns and temporal variations in the burden of CKD in China, Japan, the United Kingdom (U.K.), and the United States (U.S.) from 1990 to 2019, and decompose the difference in CKD disease burden between 1990 and 2019 into demographic factors. From 1990 to 2019, although the age-standardized rate (ASR) of incidence remained stable in the four countries, and the ASR of mortality and disability-adjusted life years (DALY) have declined in four countries (except for the increase in U.S.), the number of CKD incidence, death, and DALY increased significantly. The average disease burden per case in U.S. has increased between 1990 and 2019, with an increasing proportion of death-related disease burden. For the CKD due to diabetes and hypertension, whose incidences accounted for < 25% of the total CKD, while it accounts for more than 70% of the deaths (except in U.K. with 54.14% in women and 51.75% in men). CKD due to diabetes and hypertension should be the focus of CKD prevention and control. Considering the high treatment costs of CKD and ESRD, it is urgent and necessary to transform CKD treatment into primary and secondary prevention., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Wen, Yang, Xie, Shi, Liu, Zhang and Yu.)

Background: The diagnosis and treatment rate of Parkinson disease (PD) with depression has a low diagnostic rate, and there is no consensus on the choice of treatment mode. This study evaluates the global research trends of scientific outputs related to depression in PD from multiple perspectives, using a bibliometric analysis and visualization tool to scientifically analyze the knowledge from the literature., Methods: Literature related to depression in PD published from 2012 to 2021 was included and selected from the Web of Science Core Collection database in October 2021. CiteSpace software was used to visualize and analyze co-occurrence analyses for countries, institutions, authors, and keywords., Results: A total of 4533 articles from the Web of Science database were included. The United States made the largest contribution with the majority of publications (1215; 29.40%). Toronto University was the most productive institution. PD, depression, quality of life, dementia, nonmotor symptom, prevalence, anxiety, Alzheimer disease, symptom, and disorder would be significantly correlated with depression in PD. The current hot spots in this field focus on the following: risk factors for depression in PD, assessment scale of depression in PD, and rehabilitation of depression in PD., Conclusions: This analysis not only reveals the current research trends and hotspots but also provides some instructive suggestions on the development of depression in PD., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2022 the Author(s). Published by Wolters Kluwer Health, Inc.)

In this study, a comprehensive evaluation of management for pathogenic microbiology laboratories is performed based on a combination of Technique for Order Preference by Similarity to an Ideal Solution (TOPSIS) and Rank Sum Ratio (RSR) methods; in addition, the basis for improving laboratory management is provided. Using the laboratory evaluation tool developed by World Health Organization and a combination of TOPSIS and RSR methods, a system of evaluation indicators for the management of Chinese pathogenic microbiology laboratories is established for comprehensively evaluating the pathogenic microbiology laboratories of seven provincial Centers for Disease Control and Prevention. The evaluation system includes 12 primary indicators and 37 secondary indicators. In terms of laboratory management, the seven laboratories were ranked as D, G, E, C, F, B, and A in descending order. None of these laboratories were evaluated as "good" or "poor." One of the laboratories was marked as "relatively poor" (A), two as "medium" (B and F), and four as "relatively good" (C, E, G, and D). In this study, a method for evaluating laboratory management using the TOPSIS and RSR methods is proposed, and a basis for comprehensively evaluating laboratory management for pathogenic microbiology laboratories is provided to reflect management practices., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Zhao, Liu, Li, Li, Liu, Guo and Zhang.)

Ticks are a large group of blood-feeding arthropods that transmit multiple human and animal pathogens and are hence of importance to public health. The tick Haemaphysalis longicornis is associated with the transmission of multiple human pathogens in Asia, and recently found invading to the United States. Here, we report the sequencing, assembly and annotation of the 3.16 gigabase genome of this species, which is larger than the previous assembled one. The present Haemaphysalis longicornis genome was characterized by 6519 scaffolds, 24,189 protein-coding genes and a high proportion of simple sequence repeats (54.72%). By genomic assembly and comparative genomic analysis, we characterized the key genes that play essential roles in iron metabolism, detoxification, and freeze tolerance of H. longicornis. Furthermore, a total of 79 endogenous viral elements were identified within the genome, which might have had a considerable impact on its evolution. Decoding the H. longicornis genome not only provides insight into the genetic underpinnings of specific biological processes but also offers the basis for the subsequent integrated control of ticks and tick-borne diseases., (Copyright © 2022 The Authors. Published by Elsevier Inc. All rights reserved.)

Background & Aims: Depression and anxiety can have negative effects on patients and are important to treat. There have been few studies of their prevalence among patients with cirrhosis. We aimed to characterize the prevalence and risk factors for depression and anxiety in a large multi-center cohort of patients with cirrhosis., Methods: We conducted a telephone-based survey of patients with cirrhosis at 3 health systems in the United States (a tertiary-care referral center, a safety net system, and a Veterans hospital) from April through December 2018. Of 2871 patients approached, 1021 (35.6%) completed the survey. Depression and anxiety were assessed using the PHQ-9 (range 0-25) and STAI (range 20-80) instruments, with clinically significant values defined as PHQ-9 ≥15 and STAI ≥40. We performed multivariate logistic regression analysis to identify factors associated with significant depression and anxiety., Results: The median PHQ-9 score was 7 (25 th percentile-75 th percentile, 3-12) and the median STAI score was 33 (25 th percentile-75 th percentile, 23-47); 15.6% of patients had moderately severe to severe depression and 42.6% of patients had high anxiety. In multivariable analyses, self-reported poor health (odds ratio [OR], 4.08; 95% CI, 1.79-9.28), being widowed (OR, 2.08; 95% CI, 1.07-4.05), fear of hepatocellular carcinoma (OR, 1.89; 95% CI, 1.04-3.42), higher household income (OR, 0.30; 95% CI, 0.10-0.95), and Hispanic ethnicity (OR, 0.57; 95% CI, 0.33-0.97) were associated with moderately severe to severe depression. Male sex (OR, 0.71; 95% CI, 0.51-0.98), self-reported poor health (OR, 2.73; 95% CI, 1.73-4.32), and fear of hepatocellular carcinoma (OR, 2.24; 95% CI, 1.33-3.78) were associated with high anxiety., Conclusions: Nearly 1 in 6 patients with cirrhosis have moderately severe to severe depression and nearly half have moderate-severe anxiety. Patients with cirrhosis should be evaluated for both of these disorders., (Published by Elsevier Inc.)

Background: The newly described ABCD-10 (age, bicarbonate, cancer, dialysis, 10% body surface area [BSA]) is a 5-item mortality prediction model for patients with Stevens-Johnson syndrome (SJS)/toxic epidermal necrolysis (TEN). It was developed in the United States, has at present been externally tested only in the United States, Spain, and Singapore, and remains to be validated in resource-restricted settings. We sought to compare the accuracy of ABCD-10 and Score of Toxic Epidermal Necrolysis (SCORTEN) in predicting in-hospital mortality in a cohort from central China. Due to disease progression affecting the accuracy of the prediction model during hospitalization, for example, higher predictive accuracy of SCORTEN based on parameters collected on day 3 of hospitalization, we also assessed the overall predictive value of ABCD-10 on days 1 and 3, respectively., Methods: A retrospective study was performed over a 10-year period (2010-2020) from 3 medical institutions in Wuhan. The performance of predictive models was assessed by both discrimination and calibration. Receiver-operating characteristic (ROC) curves, Hosmer-Lemeshow goodness-of-fit tests and calibration plots were used to evaluate the model discrimination and calibration., Results: Of 84 included patients, 11 (13.1%) did not survive. The discrimination power of ABCD-10 was not significantly different from that of SCORTEN (area under the curve: day 1, p > 0.05; day 3, p > 0.05). Although the calibration of ABCD-10 was good, it was inferior to SCORTEN as it underestimated total mortality (Hosmer-Lemeshow goodness-of-fit test: day 1, p = 0.17 vs. p = 0.63; day 3, p = 0.35 vs. p = 0.93). Besides, the performance of ABCD-10 was slightly better on day 3 relative to day 1. During hospitalization, bacteremia developed in 21 (25.0%) patients, which was associated with a higher risk of death in our cohort (odds ratio, 22.88; 95% CI, 4.38-119.40; p < 0.001)., Conclusion: ABCD-10 showed acceptable overall performance, but revealed mortality underestimation and was inferior to the performance of SCORTEN. In consistence with SCORTEN, ABCD-10 was a better model when using values collected at day 3 of hospitalization relative to day 1., (© 2021 S. Karger AG, Basel.)

Objectives: Coronavirus disease 2019 (COVID-19) patients may have varying degrees of hyperlipasemia. The aim was to compare outcomes among different levels of hyperlipasemia in patients with COVID-19., Methods: This is a retrospective study examining outcomes among hospitalized COVID-19 patients with a lipase <3× upper limit of normal (ULN), asymptomatic hyperlipasemia (>3× ULN), secondary pancreatitis (typical respiratory COVID-19 symptoms and found to have pancreatitis), and primary pancreatitis (presenting with pancreatitis)., Results: Of 11,883 patients admitted with COVID-19, 1560 patients were included: 1155 patients had normal serum lipase (control group), 270 had elevated lipase <3× ULN, 46 patients had asymptomatic hyperlipasemia with lipase >3× ULN, 57 patients had secondary pancreatitis, and 32 patients had primary pancreatitis. On adjusted multivariate analysis, the elevated lipase <3× ULN and asymptomatic hyperlipasemia groups had worse outcomes with higher mortality (odds ratio [OR], 1.6 [95% confidence interval [CI], 1.2-2.2) and 1.1 [95% CI, 0.5-2.3], respectively), higher need for mechanical ventilation (OR, 2.8 [95% CI, 1.2-2.1] and 2.8 [95% CI, 1.5-5.2], respectively), and longer length of stay (OR, 1.5 [95% CI, 1.1-2.0] and 3.16 [95% CI, 1.5-6.5], respectively)., Conclusions: Patients with COVID-19 with elevated lipase <3× ULN and asymptomatic hyperlipasemia have generally worse outcomes than those with pancreatitis., Competing Interests: P.C.B. is a consultant for Olympus America, Apollo Medical, FujiFilm, and Boston Scientific. J.M.B. is a consultant and speaker for Abbvie Inc. A.J.T. is a consultant for Olympus America and Pentax Medical. The remaining authors declare no conflict of interest., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

There is little evidence regarding the association between serum vitamin B6 concentration and subsequent mortality. We aimed to evaluate the association of serum vitamin B6 concentration with all-cause, cardiovascular disease (CVD), and cancer mortality in the general population using data from the National Health and Nutrition Examination Survey (NHANES). Our study examined 12,190 adults participating in NHANES from 2005 to 2010 in the United States. The mortality status was linked to National Death Index (NDI) records up to 31 December 2015. Pyridoxal 5'-phosphate (PLP) is the biologically active form of vitamin B6. Vitamin B6 status was defined as deficient (PLP < 20 nmol/L), insufficient (PLP ≥ 20.0 and <30.0 nmol/L), and sufficient (PLP ≥ 30.0 nmol/L). We established Cox proportional-hazards models to estimate the associations of categorized vitamin B6 concentration and log-transformed PLP concentration with all-cause and cause-specific mortality by calculating hazard ratios (HRs) and 95% confidence intervals (95%CIs). In our study, serum vitamin B6 was sufficient in 70.6% of participants, while 12.8% of the subjects were deficient in vitamin B6. During follow-up, a total of 1244 deaths were recorded, including 294 cancer deaths and 235 CVD deaths. After multivariate adjustment in Cox regression, participants with higher serum vitamin B6 had a 15% (HR = 0.85, 95%CI = 0.77, 0.93) reduced risk of all-cause mortality and a 19% (HR = 0.81, 95%CI = 0.68, 0.98) reduced risk for CVD mortality for each unit increment in natural log-transformed PLP. A higher log-transformed PLP was not significantly associated with a lower risk for cancer mortality. Compared with sufficient vitamin B6, deficient (HR = 1.37, 95%CI = 1.17, 1.60) and insufficient (HR = 1.19, 95%CI = 1.02, 1.38) vitamin B6 level were significantly associated with a higher risk for all-cause mortality. There was no significant association for cause-specific mortality. Participants with higher levels of vitamin B6 had a lower risk for all-cause mortality. These findings suggest that maintaining a sufficient level of serum vitamin B6 may lower the all-cause mortality risk in the general population.