Dietary Patterns Derived from UK Supermarket Transaction Data with Nutrient and Socioeconomic Profiles

Poor diet is a leading cause of death in the United Kingdom (UK) and around the world. Methods to collect quality dietary information at scale for population research are time consuming, expensive and biased. Novel data sources offer potential to overcome these challenges and better understand population dietary patterns. In this research we will use 12 months of supermarket sales transaction data, from 2016, for primary shoppers residing in the Yorkshire and Humber region of the UK (n = 299,260), to identify dietary patterns and profile these according to their nutrient composition and the sociodemographic characteristics of the consumer purchasing with these patterns. Results identified seven dietary purchase patterns that we named: Fruity; Meat alternatives; Carnivores; Hydrators; Afternoon tea; Beer and wine lovers; and Sweet tooth. On average the daily energy intake of loyalty card holders -who may buy as an individual or for a household- is less than the adult reference intake, but this varies according to dietary purchase pattern. In general loyalty card holders meet the recommended salt intake, do not purchase enough carbohydrates, and purchase too much fat and protein, but not enough fibre. The dietary purchase pattern containing the highest amount of fibre (as an indicator of healthiness) is bought by the least deprived customers and the pattern with lowest fibre by the most deprived. In conclusion, supermarket sales data offer significant potential for understanding population dietary patterns.     

Limited Association between the Total Healthy Eating Index-2015 Score and Cardiovascular Risk Factors in Individuals with Long-Standing Spinal Cord Injury: An Exploratory Study: An Exploratory Study

BackgroundThe healthy eating index-2015 (HEI-2015) reflects diet quality in reference to the 2015-2020 Dietary Guidelines for Americans (DGA). Little is known regarding its application in individuals with chronic spinal cord injury (SCI).ObjectiveTo explore the relationship between diet quality as assessed by the HEI-2015 and cardiovascular risk factors among individuals with chronic SCI.DesignThis is a cross-sectional analysis of baseline data collected from August 2017 through November 2019 for an interventional study that evaluates the effects of a high-protein/low-carbohydrate diet on cardiovascular risk factors in individuals with chronic SCI at the University of Alabama at Birmingham.Participants/settingTwenty-four free-living adults with SCI (mean age, 45 ± 12 y; 8F/16M, level of injury: nine cervical, 15 thoracic; mean duration of injury: 20 ± 13 y) were included.Main outcome measuresParticipants underwent a 2-hour oral glucose tolerance test (OGTT) and a dual-energy x-ray absorptiometry scan. Dietary intake was assessed by three, 24-hour multiple-pass dietary recalls to calculate the HEI-2015 using the simple HEI scoring algorithm method.Data analysisMultiple linear regression analyses were performed to predict indices of lipid metabolism and glucose homeostasis and C-reactive protein (CRP) from the HEI-2015. Principal component analysis was used to reduce the number of covariates (level of injury, sex, and body fat percentage).ResultsOn average, participants’ diets were of low quality (HEI-2015, 47.2 ± 10.8). The regression models for fasting glucose (FG), cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and CRP had moderate to large effect sizes (adjusted R² ≥ 13%), suggesting good explanatory abilities of the predictors. Small or limited effect sizes were observed for glucose tolerance, fasting insulin, triglycerides, and Matsuda index (adjusted R² < 13%). The HEI-2015 accounted for a moderate amount of variation in FG (partial omega-squared, ω_P² = 13%). Each 10-point HEI-2015 score increase was associated with a 3.3-mg/dL decrease in FG concentrations. The HEI-2015 accounted for a limited amount of variation in other indices (ω_P² < 5%).ConclusionsAmong participants with SCI, higher conformance to the 2015-2020 DGA was 1) moderately associated with better FG homeostasis; and 2) trivially associated with other cardiovascular risk factors. Because of the small sample size, these conclusions cannot be extrapolated beyond the study sample. Future larger studies are warranted to better understand the relationship between diet quality and cardiovascular disease risks in this population.     

Clustering 5-Year Multidimensional Health Care Trajectory Patterns in Alzheimer's Disease and Related Syndromes

ObjectiveAfter diagnosis of Alzheimer's disease and related syndromes (ADRS), personalized care adapted to each patient's needs is recommended to provide a care plan and start symptomatic treatments according to guidelines. Over the past decade, dedicated structures and care have been implemented in various settings. Equal access to ADRS care, health care providers and services is crucial to ensure potential health benefits for everyone. However, the extent of use of recommended services and favorable health care utilization trajectories (HUT) may vary according to individual and contextual characteristics. The aim of this article was to (1) describe HUT patterns after multidimensional clustering of similar trajectories, (2) assess the proportion of individuals presenting favorable HUTs, and (3) identify factors associated with favorable HUTs.DesignCohort study.Setting and participantsA cohort of 103,317 people newly diagnosed with ADRS identified in the French health reimbursement system (SNDS) was followed for 5 years with their monthly utilization on 11 health care dimensions.MethodsFor 3 age groups (65–74, 75–84, ≥85 years), 15 clusters of patients were identified using partitioning around medoids applied to Levenshtein distances. They were qualitatively assessed by pluridisciplinary experts. Individual and contextual determinants of clusters denoting favorable trajectories were identified using mixed random effects multivariable logistic regression models.ResultsClusters with favorable HUTs denoting slow, progressive trajectories centered on at-home care, represented approximatively 25% of the patients. Determinants of favorable HUTs were mostly individual (age, female gender, absence of certain comorbidities, circumstances of ADRS identification, lower deprivation). Contextual determinants were also identified, in particular accessibility to nurses and nursing homes. Inter-territories variance was small but significant in all age groups (from 0.9% to 1.8%).Conclusion and implicationsFavorable HUTs remain the minority and many efforts can still be made to improve HUTs. Qualitative studies could help understanding underlying barriers to favorable HUTs.     

胎心监护不同图型对胎儿预后的评价

目的：通过研究胎心监护不同图型与脐血血气分析和新生儿Apgar评分关系来探讨早期诊断胎儿宫内缺氧的方法。方法：随机收集足月单胎产妇144例在产前做胎心监护,分娩时测脐动脉血气,出生后行Apgar评分,结果：随着脐血pH值降低,胎心监护异常图型及新生儿Apgar低评分发生率越高。胎心监护正常提示胎儿宫内情况良好的准确性达80．73％,在胎儿监护异常图型中,以pH≤7．20作为缺氧标准诊断符合率为50．82％,而以Apgar评分＜7分作为诊断标准的符合率仅为27．87％,各种胎心监护异常图形对胎儿预后影响差异有显著意义,P＜0．005,结论：正常胎心监护图型预报胎儿预后好的准确率高,胎心监护异常时,应严密监护,根据胎心率异常的程度,胎儿能够娩出的时间,选择恰当的处理方法,即可减少围产儿病率及死亡率。     

心肌多普勒组织显像与心肌增厚率相关分析

目的：研究脉冲多普勒组织显像评价室壁运动的可行性。方法：对19例研究对象左室基底段心肌进行脉冲多普勒组织显像并测量最大收缩速度及心肌收缩平均加速度和在同一部位的M-mode运动轨迹上测量心肌增厚率,对其进行相关回归分析。结果：心肌脉冲多普勒显像的最大收缩速度与M-Mode测量的心肌增厚率呈中度相关（r=0.55,P＜0.05),脉冲多普勒组织显像的心肌收缩平均加速度与M-mode的心肌增厚率呈中度相关（r=0.56,P＜0.05)。结论：脉冲多普勒组织显像显示的心肌最大收缩速度和心肌收缩平均加速度可作为评价室壁节段运动的指标。     

MRCP诊断梗阻性黄疸的价值评价

目的：探讨共振胆胰管成像（MRCP）在梗阻性黄疸定位、定性诊断中的应用价值。方法：采用重T2加权TSE序列采集、MIP法三重建,并与US、CT、ERCP／PTC及手术和病理相对照。结果：MRCP定位诊断准确率达100％,优于US（P＜0．05）,与CT、ERCP／TPC无显著差异;MRCP结合常规MRI定性诊断准确率达89．7％,优于US（P＜0．025）,与CT、ERCP／PIC无显著差异。结论：MRCP安全、简便、无创伤,在梗阻性黄疸的定位、定性诊断上具有很高的敏感性、准确性,是诊断性ERCP／PTC的有效替代方法。     

核素三相骨显像在骨缺损移植修复中的价值

目的评价放射性核素三相骨显像在骨缺缺损移植修复过程中的价值.方法试验动物前肢分为骨形态形成蛋白(BMP)和纤维蛋白粘和剂(FS)复和物组(A)、FS组(B)和空白组(C),于术后1、2、4、8周分别行99mTc-MDP三相骨显像和组织学检查,并把所得结果进行比较.结果三相骨显像A组呈持续高灌注、高摄取,B、C组则在第1、2周为高灌注,而后渐下降.各时间段摄取比组间比较AvsB、AvsC P＜0.001,BvsC术后2周P＜0.05,术后第4、8周P＞0.05.组织学检查与骨显像结果吻合良好.结论三相骨显像是骨缺损修复过程中的一种理想监测方法.     

三维测量技术在骨性Ⅲ类错颌双颌术后复发研究中的应用

目的探讨三维测量方法应用于骨性Ⅲ类错颌畸形患者正颌术后颌骨稳定性研究的可行性,分析术后颌骨的复发情况及其影响因素。方法以2019年7至12月于南京大学医学院附属口腔医院口腔颌面外科行双颌手术的骨性Ⅲ类错颌畸形患者为研究对象,患者均行上颌Le Fort Ⅰ型截骨术+双侧下颌矢状劈开术。收集患者术前1周(T0)、术后3 d(T1)、术后6~12个月(T2)螺旋CT数据,使用3D Slicer建模并导入Geomagic Qualify拟合配准、测量上、下颌骨各标志点三维移动距离。对T1、T2期各标志点坐标值行配对t检验或Wilcoxon符号秩和检验,并对有明显复发的标志点之间行Pearson相关性分析,P < 0.05为差异有统计学意义。结果共纳入15例患者,其中男5例,女10例,年龄18~25岁,平均21.3岁。T1与T2期各标志点水平向坐标值比较,仅在右下颌角点差异有统计学意义,T1期为(-50.47±4.44) mm,T2期为(-50.06±4.66) mm(t=2.948,P=0.011)。T1与T2期各标志点前后向坐标值比较,上颌骨上牙槽座点、左、右梨状孔点、左、右骨折线中点差异有统计学意义(P<0.05),复发率分别为37.7 %(1.36/3.61)、35.7%(1.15/3.22)、25.4%(0.84/3.31)、26.9%(0.84/3.12)、14.0%(0.41/2.92);下颌骨下牙槽座点、颏前点、颏顶点、颏下点、左、右下颌角点差异有统计学意义(P<0.01),复发率分别为36.9%(1.75/4.74)、53.9%(2.45/4.55)、55.5%(2.72/4.90)、61.7%(2.90/4.70)、85.3%(2.20/2.58)、93.4%(2.40/2.57);复发距离与移动距离均显著相关(r值为0.572~0.736,P < 0.05)。T1、T2期垂直向各标志点坐标值比较,上颌骨垂直向差异无统计学意义(P>0.05);下颌骨下牙槽座点、颏前点、颏顶点、颏下点差异有统计学意义(P<0.01),T2期较T1期发生明显的逆时针旋转。结论三维测量方法可准确反映骨性Ⅲ类错颌畸形患者双颌术后颌骨的三维变化,术后上、下颌骨在水平向均无明显复发,在前后向均存在复发,与手术距离显著相关,在垂直向仅下颌骨存在旋转移位。     

动态增强磁共振成像在评估女性乳房乳头乳晕血供的应用

目的探究动态增强磁共振成像(DCE-MRI)用于评估女性乳房乳头乳晕血供特点的可行性,为乳房整形手术提供乳头乳晕的血供参考。方法从2012年3月至2019年10月华中科技大学同济医学院附属同济医院影像数据库中收集女性乳腺DCE-MRI图像资料,选择未发现肿物的正常乳房的DCE-MRI图像进行研究。在西门子工作站将患者乳腺DCE-MRI图像通过图像减影获取乳房血管图像,分别对轴位、冠状位和矢状位的最大密度投影(MIP)图像进行评估,结合三维MIP图像识别所有供应乳头乳晕的血管。乳头乳晕的血供被划分为内上、内侧、内下、外上、外侧、外下、中央、上方和下方9个象限,对各个象限血管进行统计和分析,并测量血管至乳房皮肤表面投影的最大距离。采用SPSS 19.0软件进行统计分析,通过卡方检验分别比较左侧与右侧乳房的乳头乳晕复合体(NAC)血供象限分布构成比。计算血管到皮肤距离的平均值、标准差及95%置信区间,通过方差分析比较各象限血管至皮肤距离的差异。P<0.05为差异具有统计学意义。结果共收集到245例患者490只女性乳房DCE-MRI图像,其中97例患者97只乳房发现有乳腺肿物,其余393只为正常乳房(97例单侧乳房、148例双侧乳房),将其作为研究对象。患者年龄23~72岁,平均43.7岁。393只乳房(左侧200只、右侧193只)共发现有637条(左侧311条、右侧326条)乳头乳晕供应血管。在637条血管中,内上象限269条(42.2%),外上180条 (28.3%),内侧57条(8.9%),下方37条(5.8%),中央30条(4.7%),内下25条(3.9%),外下25条(3.9%),上方11条(1.7%),外侧3条(0.5%)。卡方检验表明左侧乳房和右侧乳房在NAC血供象限分布构成比差异无统计学意义(χ2 =6.4,P=0.602)。除中央象限血管以外,所有血管到皮肤表面投影最大距离的平均值为0.91 cm, 95%置信区间为0.86~0.96 cm。方差分析表明各象限供血血管到皮肤投影的最大距离,差异有统计学意义(F=11.4,P<0.001)。结论 DCE-MRI可以清晰地显示乳头乳晕的血供来源。乳头乳晕血供主要来源于内上象限和外上象限的血管,血管在皮下约1 cm深度走行。