The use of text messages as an alternative invitation method for breast cancer screening:A randomized controlled trial (M-TICS study)

This study aimed to determine whether a text message is as good as a postal letter as an invitation method for previous screenees in a breast cancer screening program, considering a non-inferiority margin of -2 percent points on participation rate. A non-inferiority randomized control trial was conducted. Women in the intervention group (n = 5,362) were invited by text message, and women in the control group (n = 5,482) were invited by letter, which is the standard invitation procedure of the program. In both groups, the invitation included a fixed appointment for mammography and a text message reminder 96 hours before the appointment. The primary outcome was screening participation rate (completing mammography within 12 weeks of invitation). Secondary outcomes included mammography attendance to initial or rescheduled appointments and cancellation rate. The intention-to-treat analysis showed a participation rate of 87.3% and 86.6% in the control and intervention groups, respectively. The difference in participation rate was -0.7 percentage points (95% confidence interval [CI], -1.8 to ∞), indicating non-inferiority of text messages compared to letter invitations. The per-protocol analysis showed similar results. Attendance at the initial appointment was higher in women who received the text message invitation compared to those in the control group (P<0.002). Women who received the invitation by letter canceled more the initial appointment scheduled compared to the text message group (21.1% and 15.1%, P<0.007). In conclusion, we found that a text message invitation for women who had previously participated in breast cancer screening was not inferior to the standard letter. This randomized controlled trial provides valuable insights into the use of alternative invitation methods for population-based cancer screening programs. However, further research is needed to determine the best timing and frequency of text messages for better outcomes and identify strategies for facilitating rescheduling or cancellation

Subcutaneous Administration of Apolipoprotein J-Derived Mimetic Peptide -[113-122]apoJ Improves LDL and HDL Function and Prevents Atherosclerosis in LDLR-KO Mice

Mimetic peptides are potential therapeutic agents for atherosclerosis. -[113-122]apolipoprotein (apo) J (-[113-122]apoJ) is a 10-residue peptide that is predicted to form a class G* amphipathic helix 6 from apoJ; it shows anti-inflammatory and anti-atherogenic properties. In the present study, we analyzed the effect of -[113-122]apoJ in low-density lipoprotein receptor knockout mice(LDLR-KO) on the development of atherosclerosis and lipoprotein function. Fifteen-week-old female LDLR-KO mice fed an atherogenic Western-type diet were treated for eight weeks with -[113-122]apoJ peptide, a scrambled peptide, or vehicle. Peptides were administered subcutaneously three days per week (200 µg in 100 µL of saline). After euthanasia, blood and hearts were collected and the aortic arch was analyzed for the presence of atherosclerotic lesions. Lipoproteins were isolated and their composition and functionality were studied. The extent of atherosclerotic lesions was 43% lower with -[113-122]apoJ treatment than with the vehicle or scramble. The lipid profile was similar between groups, but the high-density lipoprotein (HDL) of -[113-122]apoJ-treated mice had a higher antioxidant capacity and increased ability to promote cholesterol efflux than the control group. In addition, low-density lipoprotein (LDL) from -[113-122]apoJ-treated mice was more resistant to induced aggregation and presented lower electronegativity than in mice treated with -[113-122]apoJ. Our results demonstrate that the -[113-122]apoJ peptide prevents the extent of atherosclerotic lesions, which could be partially explained by the improvement of lipoprotein functionality

Effectiveness and acceptability of targeted text message reminders in colorectal cancer screening:a randomised controlled trial (M-TICS study)

Background:Mobile phone text message reminders to increase colorectal cancer (CRC) screening participation have shown moderate effects.Objective:This study assessed effectiveness and acceptability of targeted text message reminders for those who picked up but did not return their screening kit at pharmacy within 14 days in a CRC screening program in Catalonia, SpainMethods:We performed a randomised control trial in the screening hub of the metropolitan area of Barcelona that covers 502,348 adults aged 50-69 years. In total, 9,369 individuals were randomised in a 1:1 ratio to receive either a text message reminder or no reminder. Main primary outcome was FIT completion rate within 126 days from FIT kit pick-up (intention-to-treat-analysis). A telephone survey assessed acceptability and appropriateness of the intervention. Cost-effectiveness of adding a text message reminder to FIT completion was also performed.Results:FIT completion rate was 77.7% in control arm and 82.6% in text message arm. Higher participation rates in intervention arm were reported independent of sex, age, socioeconomic level, and screening profiles. 89.2% of interviewees considered it important and useful to receive text message reminders to FIT completion, and 93.4% preferred text messages to postal letters.Conclusions:Adding text message reminders to the standard procedure significantly increased FIT kit return rates and was considered acceptable and appropriate. The SMS plus letter reminder to complete and return the FIT kit was a cost-effective strategy. Clinical Trial: Registration Number NCT04343950 (04/09/2020) at clinicaltrials.go

Text messaging as a tool to improve cancer screening programs (M-TICS Study):A randomized controlled trial protocol

Background: Short message service (SMS) based interventions are widely used in healthcare and have shown promising results to improve cancer screening programs. However, more research is still needed to implement SMS in the screening process. We present a study protocol to assess the impact on health and economics of three targeted SMS-based interventions in population-based cancer screening programs. Methods/design: The M-TICs study is a randomized controlled trial with a formal process evaluation. Participants aged 50-69 years identified as eligible from the colorectal cancer (CRC) and breast cancer (BC) screening program of the Catalan Institute of Oncology (Catalonia, Spain) will be randomly assigned to receive standard invitation procedure (control group) or SMS-based intervention to promote participation. Two interventions will be conducted in the CRC screening program: 1) Screening invitation reminder: Those who do not participate in the CRC screening within 6 weeks of invite will receive a reminder (SMS or letter); 2) Reminder to complete and return fecal immunochemical test (FIT) kit: SMS reminder versus no intervention to individuals who have picked up a FIT kit at the pharmacy and they have not returned it after 14 days. The third intervention will be performed in the BC screening program. Women who had been screened previously will receive an SMS invitation or a letter invitation to participate in the screening. As a primary objective we will assess the impact on participation for each intervention. The secondary objectives will be to analyze the cost-effectiveness of the interventions and to assess participants' perceptions. Expected results: The results from this randomized controlled trial will provide important empirical evidence for the use of mobile phone technology as a tool for improving population-based cancer screening programs. These results may influence the cancer screening invitation procedure in future routine practice

Pancreatic cancer risk in relation to lifetime smoking patterns, tobacco type, and dose-response relationships.

BACKGROUND: Despite smoking being a well-established risk factor for pancreatic cancer (PC), there is a need to further characterize PC risk according to lifespan smoking patterns and other smoking features. Our aim was to deeply investigate them within a large European case-control study. METHODS: Tobacco smoking habits and other relevant information was obtained from 2,009 cases and 1,532 controls recruited in the PanGenEU study using standardized tools. Multivariate logistic regression analysis was performed to evaluate PC risk by smoking characteristics and interactions with other PC risk factors. Fractional polynomials and restricted cubic splines were used to test for non-linearity of the dose-response relationships and to analyse their shape. RESULTS: Relative to never-smokers, current smokers (OR=1.72, 95%CI: 1.39-2.12), those inhaling into the throat (OR=1.48, 95%CI: 1.11-1.99), chest (OR=1.33, 95%CI: 1.12-1.58), or using non-filtered cigarettes (OR=1.69, 95%CI: 1.10-2.61), were all at an increased PC risk. PC risk was highest in current black tobacco smokers (OR=2.09, 95%CI: 1.31-3.41), followed by blond tobacco smokers (OR=1.43, 95%CI: 1.01-2.04). Childhood exposure to tobacco smoke relative to parental smoking was also associated with increased PC risk (OR=1.24, 95%CI: 1.03-1.49). Dose-response relationships for smoking duration, intensity, cumulative dose, and smoking cessation were non-linear and showed different shapes by tobacco type. Effect modification by family history of PC and diabetes was likely. CONCLUSIONS: This study reveals differences in PC risk by tobacco type and other habit characteristics, as well as non-linear risk associations. IMPACT: This characterization of smoking-related PC risk profiles may help in defining PC high-risk populations

The evolution of the ventilatory ratio is a prognostic factor in mechanically ventilated COVID-19 ARDS patients

Background: Mortality due to COVID-19 is high, especially in patients requiring mechanical ventilation. The purpose of the study is to investigate associations between mortality and variables measured during the first three days of mechanical ventilation in patients with COVID-19 intubated at ICU admission. Methods: Multicenter, observational, cohort study includes consecutive patients with COVID-19 admitted to 44 Spanish ICUs between February 25 and July 31, 2020, who required intubation at ICU admission and mechanical ventilation for more than three days. We collected demographic and clinical data prior to admission; information about clinical evolution at days 1 and 3 of mechanical ventilation; and outcomes. Results: Of the 2,095 patients with COVID-19 admitted to the ICU, 1,118 (53.3%) were intubated at day 1 and remained under mechanical ventilation at day three. From days 1 to 3, PaO2/FiO2 increased from 115.6 [80.0-171.2] to 180.0 [135.4-227.9] mmHg and the ventilatory ratio from 1.73 [1.33-2.25] to 1.96 [1.61-2.40]. In-hospital mortality was 38.7%. A higher increase between ICU admission and day 3 in the ventilatory ratio (OR 1.04 [CI 1.01-1.07], p = 0.030) and creatinine levels (OR 1.05 [CI 1.01-1.09], p = 0.005) and a lower increase in platelet counts (OR 0.96 [CI 0.93-1.00], p = 0.037) were independently associated with a higher risk of death. No association between mortality and the PaO2/FiO2 variation was observed (OR 0.99 [CI 0.95 to 1.02], p = 0.47). Conclusions: Higher ventilatory ratio and its increase at day 3 is associated with mortality in patients with COVID-19 receiving mechanical ventilation at ICU admission. No association was found in the PaO2/FiO2 variation

Clustering COVID-19 ARDS patients through the first days of ICU admission. An analysis of the CIBERESUCICOVID Cohort

Background Acute respiratory distress syndrome (ARDS) can be classified into sub-phenotypes according to different inflammatory/clinical status. Prognostic enrichment was achieved by grouping patients into hypoinflammatory or hyperinflammatory sub-phenotypes, even though the time of analysis may change the classification according to treatment response or disease evolution. We aimed to evaluate when patients can be clustered in more than 1 group, and how they may change the clustering of patients using data of baseline or day 3, and the prognosis of patients according to their evolution by changing or not the cluster.Methods Multicenter, observational prospective, and retrospective study of patients admitted due to ARDS related to COVID-19 infection in Spain. Patients were grouped according to a clustering mixed-type data algorithm (k-prototypes) using continuous and categorical readily available variables at baseline and day 3.Results Of 6205 patients, 3743 (60%) were included in the study. According to silhouette analysis, patients were grouped in two clusters. At baseline, 1402 (37%) patients were included in cluster 1 and 2341(63%) in cluster 2. On day 3, 1557(42%) patients were included in cluster 1 and 2086 (57%) in cluster 2. The patients included in cluster 2 were older and more frequently hypertensive and had a higher prevalence of shock, organ dysfunction, inflammatory biomarkers, and worst respiratory indexes at both time points. The 90-day mortality was higher in cluster 2 at both clustering processes (43.8% [n = 1025] versus 27.3% [n = 383] at baseline, and 49% [n = 1023] versus 20.6% [n = 321] on day 3). Four hundred and fifty-eight (33%) patients clustered in the first group were clustered in the second group on day 3. In contrast, 638 (27%) patients clustered in the second group were clustered in the first group on day 3.Conclusions During the first days, patients can be clustered into two groups and the process of clustering patients may change as they continue to evolve. This means that despite a vast majority of patients remaining in the same cluster, a minority reaching 33% of patients analyzed may be re-categorized into different clusters based on their progress. Such changes can significantly impact their prognosis

The load of dyspnoea on brain and legs

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Geochemistry and isotope composition (Sr, Pb, δ⁶⁶Zn) of Vulcano fumaroles (Aeolian Islands, Italy)

We present and discuss temperatures, major and trace element gas geochemistry, radiogenic isotopes (Pb, Sr) and the first Zn isotope data of fumarole condensates and altered rocks from the Vulcano fumarolic field. The fumaroles of the La Fossa cone, sampled on 5th May 2015, have temperatures ranging between 233 and 427 °C. They plot compositionally on the mixing trend between the magmatic and hydrothermal end-members defined by previous studies, but are strongly displaced towards the hydrothermal component. Correlations of radiogenic (Sr, Pb) and stable isotopes of Zn with δ13CCO2 and several trace elements of the fumarolic acid condensates support mixing between the above mentioned distinct (magmatic and hydrothermal) fluids. The magmatic end- member has a less radiogenic Sr (87Sr/86Sr ~0.7045) and heavier Zn isotope composition (δ66Zn ~0.3‰). The hydrothermal fluid end-member has a more radiogenic 87Sr/86Sr signature (> 0.7055), which could be due to leaching of radiogenic Sr from the crystalline basement rocks or reflect seawater Sr. It is also characterized by lighter Zn isotope composition (δ66Zn < −0.3), most likely reflecting equilibrium fractionation of Zn isotopes during precipitation of sphalerite (ZnS) from the hydrothermal fluid. Nonetheless, some scatter in the correlation trends suggests either the involvement of additional (subordinate) source(s) or temporal variations in isotopic and chemical compositions of the two above end-members. Pb isotope compositions of the fumaroles sampled in this study show a shift towards less radiogenic values compared to pre-2001 fumaroles. This could indicate either a change in the hydrothermal circulation pattern (leading to leaching of rocks with different isotopic compositions) or the involvement of a new, isotopically distinct, magmatic fluid. The alteration zones around the fumarole vents are also characterized by systematic correlations of Pb and Zn isotopes with major and trace elements. We interpret these as the result of the addition onto the substratum volcanic rock of Pb and Zn from the fumaroles. Zn isotope signatures of the alteration zones are significantly heavier than those of the corresponding fumaroles (δ66Zn = 0.3–1.6) probably due to equilibrium fractionation occurring during sphalerite precipitation at the vent discharge