7-year Follow-up Research Articles

Use of Bioceramic Repair Material as Root Canal Sealer for Management of Bilateral Dens Invaginatus: A Case Report with a 7-Year Follow-Up

Use of Bioceramic Repair Material as Root Canal Sealer for Management of Bilateral Dens Invaginatus: A Case Report with a 7-Year Follow-Up

Abstract P115: Hypothetical Blood Pressure Lowering Interventions and Risk of Mortality in Middle-Aged and Older Chinese Adults: A Population-Based Modelling Study

Background: Improving hypertension control is an important global health priority. We aimed to study the effects of hypothetical interventions on systolic blood pressure (SBP) on mortality risk at the population level. Methods: We estimated the relationship between SBP and all-cause mortality in adults aged 45 years and older from the China Health and Retirement Longitudinal Study and compared the mortality reductions associated with lowering SBP to different hypothetical targets (120, 130, 140, 150 mm Hg). Using the parametric g-computation modeling technique, we estimated the mean blood pressure reduction required to achieve each target, the share of the population in need of management, and the number needed to treat (NNT) to avert one death under different hypothetical population-wide scale-up scenarios. Results: Among 12355 participants, 1203 died over 7-year follow-up. We found a weak, non-linear relationship between SBP and mortality, with larger incremental mortality benefits at higher SBP values: reducing SBP from 160 mm Hg to 120 mm Hg was associated with a relative risk of mortality of 0.75 (95% CI 0.65 to 0.86). At the population level, reducing SBP to 120 mm Hg among all those with a starting SBP of more than 120 mm Hg (120 mm Hg scenario) was associated with 13.7 deaths averted per 1000 population (95% CI -19.3 to -8.1), compared with 3.8 deaths averted per 1000 population (95% CI -6.0 to -1.6) associated with reducing SBP to 150 mm Hg among all those with a starting SBP of more than 150 mm Hg (150 mm Hg scenario). However, there were large differences between scenarios in the proportion of the population that would require treatment, ranging from 64.3% (95% CI 63.4 to 65.1) in the 120 mm Hg scenario to 16.7% (6.0 to 17.3) in the 150 mm Hg scenario. To achieve the target, the 120 mm Hg scenario required a mean shift of -14.4 mm Hg in SBP (95% CI -14.7 to -14.1) compared with a -2.9 mm Hg mean change (-3.0 to -2.7) for the 150 mm Hg scenario. Based on the ratio of number of deaths averted to the proportion requiring treatment, the 150 mm Hg scenario had the smallest NNT (n=44), followed by the 120 mm Hg scenario (n=47), the 140 mm Hg scenario (n=49), and the 130 mm Hg scenario (n=51). Conclusions: These findings highlight the possible substantial benefits of reducing blood pressure. We find that scaling up management based on a 150 mm Hg target is more efficient in terms of the NNT compared with strategies to reduce SBP to lower levels.

Association between functional dependence and cardiovascular disease among middle-aged and older adults: Findings from the China health and retirement longitudinal study

BackgroundThe effect of different functional dependency types on cardiovascular disease (CVD) is largely unknown. Here, we aimed to investigate the association between functional dependence and CVD among middle-aged and older adults by conducting a cross-sectional and longitudinal study. MethodsThe study sample comprised 16,459 individuals of ≥40 years (including 10,438 without CVD) who had participated in the 2011 China Health and Retirement Longitudinal Study (CHARLS). Functional dependence was categorized based on the “interval-of-need” method, while CVD was defined as physician-diagnosed heart disease or stroke. Cox proportional hazard regression was employed to assess the effects of functional dependence on CVD. Moreover, patients were grouped according to the functional status changes, and the impact of these changes on CVD was observed. Heterogeneity, subgroup, and interaction analyses were used to evaluate the consistency of the study findings. Finally, a mediation analysis was performed to estimate the potential mediation effects on the relationship between functional dependence and CVD risk. ResultsCVD prevalence in the overall study population was 13.73 % (2260/16,459), while its prevalence among individuals with functional independence, low dependency, medium dependency, and high dependency was 9.60 % (1085/11,302), 14.25 % (119/835), 17.72 % (115/649), and 25.01 % (941/3763), respectively. Additionally, medium (odds ratio: 1.33, 95 % confidence interval: 1.06–1.68) and high functional dependency (1.55, 95 % CI: 1.38–1.75) were associated with CVD. A total of 2987 (28.62 %) participants with CVD were identified during the 9-year follow-up, with 4.85 % (145/2987) of the CVD cases being attributed to functional dependence. The individuals with medium (HR: 1.20, 95 % CI: 1.01–1.44) and high functional dependency (1.25, 95 % CI: 1.14–1.37) were more likely to develop CVD than their peers with functional independence. Furthermore, persistent functional dependence (HR: 1.72, 95 % CI: 1.52–1.94) and transition from functional independence to dependence (1.79, 95 % CI: 1.61–1.98) were associated with a higher CVD risk than continuous functional independence. Hypertension and diabetes may partially mediate CVD caused by functional dependence. ConclusionFunctional dependence is associated with high CVD risk. Therefore, appropriate healthcare attention must be directed towards functionally dependent populations to protect their cardiovascular health.

Nonoperative Management of High Ankle Sprains: A Case Series With ≥18-Year Follow-up

Background: High ankle sprains are common athletic injuries and can be associated with long-term sequelae. Regardless of operative or nonoperative treatment, there is a paucity of data in the literature about the long-term outcomes of high ankle sprains. Hypothesis: Nonoperative treatment of high ankle sprains utilizing a standardized protocol will result in good long-term outcomes. Study Design: Case series; Level of evidence, 4. Methods: Patients who experienced a high ankle sprain without radiographic diastasis of the syndesmosis were identified from a previous study database and contacted for long-term follow-up. All patients were high school or National Collegiate Athletic Association Division IA athletes at initial injury and were treated nonoperatively with the same standardized protocol. Patients completed a questionnaire that included documentation of any interim ankle injuries, 2 different patient-reported outcome scores, and ankle radiographs to conduct Kellgren-Lawrence scoring for ankle osteoarthritis. Results: In total, 76 cases in 74 patients were identified in the database. A total of 40 patients were successfully contacted, and 31 patients (24 collegiate and 7 high school athletes) with 33 high ankle sprains completed the survey (31/40; 77.5%). The mean age at follow-up was 45 years (range, 34-50 years), with a mean time from injury to follow-up of 25 years. Overall, 93.5% (n = 29) of the respondents were male, and 42% (n = 13) of the respondents reported an ipsilateral ankle injury since their initial injury, with 16% (n = 5) having ankle or Achilles surgery. The mean Patient-Reported Outcomes Measurement Information System-10 score was 53.4 (SD, 8.3; range, 37.4-67.7), PROMIS median (IQR), 54.1 (39.9, 68.3), and the mean Self-reported Foot and Ankle Score score was 42.7 (SD, 5.86). Follow-up ankle radiographs were obtained in 11 (35%) of the respondents; 27% had Kellgren-Lawrence grade >2 osteoarthritis, and 36% had signs of heterotopic ossification on imaging. The mean tibiofibular clear space was 4.5 mm, and the mean tibiofibular overlap was 7.15 mm, with 27% of patients demonstrating some tibiotalar narrowing. Conclusion: At long-term follow-up, nonoperative management of high ankle sprains without diastasis on imaging was associated with acceptable patient-reported functional outcomes and low rates of subsequent ankle injuries. There was a high incidence of arthritis, but most cases were not clinically significant. This case series shows the natural history of nonoperatively treated high ankle sprains and may serve as a comparison for different management techniques in the future.

409P Biological tumor traits predicting late recurrence in premenopausal breast cancer patients: Insights from the STO-5 trial with 20-year follow-up

409P Biological tumor traits predicting late recurrence in premenopausal breast cancer patients: Insights from the STO-5 trial with 20-year follow-up

300P Gene expression landscape of the long-term tamoxifen resistance in premenopausal ER+ breast cancer patients in the STO-5 controlled randomized clinical trial with >20-year follow-up

300P Gene expression landscape of the long-term tamoxifen resistance in premenopausal ER+ breast cancer patients in the STO-5 controlled randomized clinical trial with >20-year follow-up

A Case of Solid-Pseudopapillary Neoplasm with 30-Year Follow-Up after Multidisciplinary Treatment for Postoperative Recurrence

A Case of Solid-Pseudopapillary Neoplasm with 30-Year Follow-Up after Multidisciplinary Treatment for Postoperative Recurrence

Assessment of 1-Hour Postload Plasma Glucose, the Metabolic Syndrome, and the Finish Diabetes Risk Score in the Prediction of Type 2 Diabetes

ObjectiveTo compare the 1-hour postload glucose (1h-PG) value of an oral glucose tolerance test (OGTT) with the metabolic syndrome (MetS) and the Finish Diabetes Risk Score (FINDRISC) in patients with impaired fasting glucose (IFG) to predict type 2 diabetes mellitus (T2DM). MethodsA cohort study conducted in patients identified at a general hospital in Lima, Perú. An OGTT was performed in subjects with IFG who were followed up for 7 years for T2DM development. The exposure variables were 1h-PG ≥ 155 mg/dL, MetS, and a FINDRISC ≥ 13 points, and the outcome was the presence of T2DM. The relative risk, confidence interval, and area under the curve (AUROC) were also estimated. ResultsAmong 324 subjects with IFG, 218 completed the 7-year follow-up. The mean age was 56.2 ± 11.5 years, 64.0% were woman, and 63.8% were overweight/obese. Of these, 36.8% had 1h-PG ≥ 155 mg/dL and normal glucose tolerance, 66.8% had MetS, and 64.5% had FINDRISC ≥ 13 points. After 7 years, 21.1% of participants developed T2DM, with 68.8% of them had 1h-PG ≥ 155 mg/dL (P < .001), 62.2% had MetS (P = .013), and 67.9% had FINDRISC ≥ 13 (P = .68). After adjusting by age, sex, and body mass index, the relative risk was 3.52 (1.64-7.54; 95% CI), 1.81 (0.96-3.38; 95% CI), and 1.17 (0.51-2.70; 95% CI) for each exposure variable, respectively. Also, the AUROC was 0.72 (0.60-0.83), 0.63 (0.51-0.75), and 0.51 (0.38-0.63) (P = .01), respectively. ConclusionBy performing an OGTT in patients with IFG, an 1h-PG ≥ 155 mg/dL value may be helpful to predict T2DM at 7 years better than the use of MetS or the FINDRISC.

The association of obesity phenotypes and risk of cardiovascular disease using time-varying and time-invariant approaches: An 18-year follow-up cohort study

Background and aimOur aim was risk estimation for cardiovascular disease (CVD) across obesity phenotypes over 18 years of follow-up using both time-invariant and time-varying approaches. MethodsThis prospective cohort study included 9752 participants aged ≥ 30 years examined in the first and second phases of the Tehran Lipid and Glucose Study (1999-2001 and 2002-2005). Six phenotypes [i.e., metabolically healthy normal weight (MHNW), overweight (MHOW), and obese (MHO), as well as metabolically unhealthy normal weight (MUNW), overweight (MUOW), and obese (MUO)] were defined based on the body mass index (BMI) and metabolic status. Incident CVD was documented until March 2018. Time-invariant and time-varying Cox regression models were used to estimate CVD hazard ratio (HRs) for obesity phenotypes. ResultsMean age of the participants was 46.6 ±12.0 years, and 53.9% of them were women. During 18 years of follow-up, 1083 new CVD events occurred. In metabolically unhealthy individuals, but not metabolically healthy people, multivariable-adjusted HRs for CVD events increased by BMI according to time-varying (HR=1.6, 95% CI=1.13-2.26 for MUNW; HR=1.92, 95% CI=1.43-2.58 for MUOW; HR=1.94, 95% CI=1.4-2.68 for MUO) and time-invariant (HR=1.85, 95% CI=1.01-3.39 for MUNW; HR=2.75, 95% CI=1.63-4.63 for MUOW, and HR=3.26, 95% CI=1.95-5.47 for MUO) models. ConclusionMetabolically unhealthy overweight and obese individuals are at increased risk of CVD and should be regularly screened to prevent possible cardiovascular events.

Long-term Outcomes of Partial Meniscectomy for Degenerative Medial Meniscus Posterior Root Tears.

Previous studies have demonstrated that medial meniscus posterior root tear (MMPRT) repair is superior to debridement in terms of patient-reported outcomes, rates of conversion to total knee arthroplasty (TKA), and long-term costs. Despite the known poor midterm outcomes, there is a paucity of long-term results of partial meniscectomy for degenerative MMPRTs. To 1) evaluate long-term patient-reported and radiographic outcomes of patients who underwent partial medial meniscectomy (PMM) for MMPRTs, and 2) determine the rate of and risk factors for conversion to total knee TKA. Case series; Level of evidence, 4. A previously identified cohort of 26 patients treated with partial meniscectomy for isolated MMPRTs between 2005 and 2013 was prospectively followed for long-term outcomes at a minimum 10-year follow-up. Patients were evaluated for International Knee Documentation Committee (IKDC) outcome score, reoperation, and conversion to TKA. Failure was defined as conversion to arthroplasty or a severely abnormal IKDC subjective score <75.4. This study included 26 patients (10 men, 16 women; mean age, 54 ± 8.7 years [range, 38-71 years] at diagnosis; body mass index, 32.9 ± 5.5) who were followed for a mean of 14.0 ± 3.6 years (range, 10.1-19.6 years). At the final follow-up, 1 patient was deceased and 18 (72%) of the remaining 25 patients had progressed to TKA, with 1 (4%) patient undergoing repeat meniscectomy. The 6 (24%) patients who had not progressed to TKA or revision surgery reported a mean IKDC score of 57 ± 23. Nineteen patients underwent subsequent surgery and 5 demonstrated severely abnormal IKDC scores resulting in a clinical failure rate of 96% (24 of the 25 living patients) at a mean 14-year follow-up. PMM for medial meniscus posterior horn root tears demonstrated 72% progression to TKA and 96% failure according to subjective clinical outcomes at a minimum 10-year follow-up.

Ten-year outcomes of hybrid coronary revascularization at a single center.

Hybrid coronary revascularization (HCR) is a well-established technique for treating multi-vessel coronary disease. There remains a paucity of discussion assessing the efficacy of HCR with respect to the timing of the surgical component relative to that of the percutaneous coronary intervention (PCI). A retrospective review was undertaken of our prospectively collected database from January 2009 to December 2019. Of 395 HCR patients analyzed, we examined the outcomes of 109 pairs of propensity-matched patients who either underwent robotic-assisted minimally-invasive direct coronary artery bypass (MIDCAB) first, or who had PCI prior to surgery. Thirty-day mortality was 0.25% (1 death) for the entire cohort. Mid-term survival for the total 'MIDCAB-first' group was 94.1% (17 deaths), not significantly different to that for the 'PCI-first' cohort (8 deaths, 92.7%), and this was also statistically comparable after propensity matching. Perioperative morbidity was not different between patient groups. Freedom from major adverse cardiac and cerebrovascular events (MACCE) and the incidence of repeat revascularization was similar between the two groups at up to 11-year follow-up. Elevated serum creatinine independently predicted increased MACCE for all patients, irrespective of the sequence of HCR revascularization employed. In appropriately selected patients with multi-vessel coronary disease, HCR is associated with excellent short and longer-term results, irrespective of whether the MIDCAB or PCI procedure is performed first.

316P Differential long-term benefit of 2-year adjuvant tamoxifen therapy for luminal-type breast cancer: Insights from a 20-year follow-up analysis of the STO trials

316P Differential long-term benefit of 2-year adjuvant tamoxifen therapy for luminal-type breast cancer: Insights from a 20-year follow-up analysis of the STO trials

Inflammation, Cholesterol, Lipoprotein(a), and 30-Year Cardiovascular Outcomes in Women.

High-sensitivity C-reactive protein (CRP), low-density lipoprotein (LDL) cholesterol, and lipoprotein(a) levels contribute to 5-year and 10-year predictions of cardiovascular risk and represent distinct pathways for pharmacologic intervention. More information about the usefulness of these biomarkers for predicting cardiovascular risk over longer periods of time in women is needed because early-life intervention represents an important risk-reduction method. We measured high-sensitivity CRP, LDL cholesterol, and lipoprotein(a) levels at baseline in 27,939 initially healthy U.S. women who were subsequently followed for 30 years. The primary end point was a first major adverse cardiovascular event, which was a composite of myocardial infarction, coronary revascularization, stroke, or death from cardiovascular causes. We calculated the adjusted hazard ratios and 95% confidence intervals across quintiles of each biomarker, along with 30-year cumulative incidence curves adjusted for age and competing risks. The mean age of the participants at baseline was 54.7 years. During the 30-year follow-up, 3662 first major cardiovascular events occurred. Quintiles of increasing baseline levels of high-sensitivity CRP, LDL cholesterol, and lipoprotein(a) all predicted 30-year risks. Covariable-adjusted hazard ratios for the primary end point in a comparison of the top with the bottom quintile were 1.70 (95% confidence interval [CI], 1.52 to 1.90) for high-sensitivity CRP, 1.36 (95% CI, 1.23 to 1.52) for LDL cholesterol, and 1.33 (95% CI, 1.21 to 1.47) for lipoprotein(a). Findings for coronary heart disease and stroke appeared to be consistent with those for the primary end point. Each biomarker showed independent contributions to overall risk. The greatest spread for risk was obtained in models that incorporated all three biomarkers. A single combined measure of high-sensitivity CRP, LDL cholesterol, and lipoprotein(a) levels among initially healthy U.S. women was predictive of incident cardiovascular events during a 30-year period. These data support efforts to extend strategies for the primary prevention of atherosclerotic events beyond traditional 10-year estimates of risk. (Funded by the National Institutes of Health; Women's Health Study ClinicalTrials.gov number, NCT00000479.).

Longitudinal associations of effort and reward at work with changes in cognitive function: evidence from a national study of U.S. workers.

This study aimed to examine longitudinal associations of workplace effort and reward with changes in cognitive function among United States workers. Data from the national, population-based Midlife in the United States (MIDUS) study with a 9-year follow-up were used. Validated workplace effort and reward scales were measured at baseline, and cognitive outcomes (including composite cognition, episodic memory, and executive functioning) were measured with the Brief Test of Adult Cognition by Telephone (BTACT) at baseline and follow-up. Multivariable linear regression analyses based on generalized estimating equations (GEE) examined the longitudinal associations under study. Among this worker sample of 1,399, after accounting for demographics, socioeconomics, lifestyle behaviors, health conditions, and job control, high reward at baseline was associated with increased composite cognition (regression coefficient: 0.118 [95% CI: 0.049, 0.187]), episodic memory (0.106 [0.024, 0.188]), and executive functioning (0.123 [0.055, 0.191]) during follow-up. The joint exposure of 'high effort and high reward' was also associated with increased composite cognition (0.130 [0.030, 0.231]), episodic memory (0.131 [0.012, 0.250]), and executive functioning (0.117 [0.017, 0.216]), while the combination of 'low effort and high reward' was associated with increased composite cognition (0.106 [0.009, 0.204]) and executive functioning (0.139 [0.042, 0.235]). Findings suggest that workplace high reward is related to improved cognitive scores among United States workers. Future research should investigate larger cohorts over longer timespans and expand into disease outcomes such as dementia. If these findings emerge as causal, relevant workplace rewards to promote worker cognitive health should be considered.

Design of the 18-year follow-up of the Danish COPSAC2000 birth cohort

BackgroundAtopic diseases, obesity and neuropsychiatric disorders are lifestyle-related and environmental-related chronic inflammatory disorders, and the incidences have increased in the last years.ObjectiveTo outline the design of the 18-year follow-up of...

Quality of Life and Primary Open-Angle Glaucoma in the Ocular Hypertension Treatment Study

If preperimetric glaucoma reduces patient-reported vision-related quality of life (VRQoL), clinicians might consider earlier and more aggressive treatment of some patients with ocular hypertension and early glaucoma. To determine the impact of preperimetric glaucoma and early glaucomatous visual field (VF) loss on participants' VRQoL compared with participants who did not develop glaucoma in the Ocular Hypertension Treatment Study (OHTS). This cross-sectional study used data from participants enrolled in the OHTS from 1994 to 1996 who completed 20-year examination follow-up and VRQoL surveys from January 7, 2016, to November 19, 2019. Diagnosis of primary open-angle glaucoma (POAG) required reproducible changes in VFs or optic discs as determined by reading centers and attributed to glaucoma by a masked end point committee. Data analysis was performed from June 27, 2023 to March 7, 2024. Ocular hypertension and glaucoma. Cross-sectional analysis of Rasch-calibrated total scores of the National Eye Institute Visual Function Questionnaire (VFQ) and the Glaucoma Quality of Life (GQL) survey was performed. Total scores were standardized from 0 (poor) to 100 (good). The main outcomes were differences in total VRQoL scores between participants who did not develop POAG (control) and 4 mutually exclusive POAG groups: unilateral or bilateral disc POAG with no glaucomatous VF loss in either eye and unilateral or bilateral VF POAG with or without disc changes. Differences in total VRQoL scores were analyzed using univariate and multivariate linear regression models. Of 1636 participants originally enrolled in the OHTS, 679 (42%) completed the 20-year examination and VRQoL surveys. Of those participants completing 20-year follow-up, mean (SD) participant age at follow-up was 73.8 (7.7) years, and 412 of 679 participants (60.7%) self-reported as female. The mean (SD) Rasch-calibrated total VFQ scores were 72.5 (13.4) in the no POAG group (control) vs 72.7 (13.8) in the unilateral disc POAG group (difference, 0.17; 95% CI, -3.17 to 3.41; P = .92), 73.4 (14.0) in the bilateral disc POAG group (difference, 0.92; 95% CI, -2.93 to 4.77; P = .64), 69.2 (14.5) in the unilateral VF POAG group (difference, 3.33; 95% CI, -6.38 to -0.27; P = .03), and 58.5 (16.9) in the bilateral VF POAG group (difference, -13.96; 95% CI, -17.73 to -10.19; P<.001). Similar results were found for the GQL questionnaire. In this cross-sectional study, among the surviving participants of OHTS who completed the 20-year follow-up examination, those participants who developed preperimetric POAG but no glaucomatous VF loss did not report lower VFQoL compared with participants who did not develop POAG. This finding should allow clinicians and patients the time to determine the frequency of examinations and whether the initiation of treatment is appropriate.

Physical activity modification over time according to socioeconomic position: results from the EPIC-Italy cohort study

ObjectivesOur study aimed to investigate how physical activity (PA) changes over an 11-year follow-up among adults from different socioeconomic positions (SEP) near retirement age. Moreover, an analysis of different PA...

Co-occurring experiences of traumatic events and substance use among young people

ObjectiveHarmful substance use among young people is concerningly prevalent. Substance use disorder (SUD) and post-traumatic stress disorder (PTSD) frequently co-occur in treatment settings and are well researched among adults but lacking among young community cohorts. The aim of this study was to explore the prevalence and relationship between substance use, SUD, trauma, and PTSD among a community sample of young people in Australia. MethodA cross-sectional examination of data collected from participants (n = 1007, 48.9 % male) aged 18–22 years (M = 20 years, SD = 0.44), who took part in the 7-year follow-up of a cluster RCT of school-based substance use prevention interventions: The Climate and Preventure (CAP) study. A series of regressions were conducted to examine the relationship between trauma-related variables and substance use outcomes. Results48.3 % experienced a traumatic event (median = 2, range = 1–11) and of those 10.9 % met a probable PTSD diagnosis. Median age of first trauma exposure was 14 years (range = 0–21). 89.9 % used substances; 73.1 % reported binge drinking, and 35.6 % met a probable diagnosis of SUD (alcohol/cannabis). Those who experienced any traumatic event had almost 1.5 times greater odds of binge drinking. Cannabis use was significantly associated with most trauma-related variables. Sexual trauma exposure was the only trauma type significantly associated with all substance use variables. ConclusionsThis study demonstrated that substance use/SUD and experiences of trauma/PTSD are prevalent among a community sample of young people. Importantly, substance use among young people is associated with experiencing a traumatic event, particularly sexual and physical types of traumatic events, and developing PTSD.

Disentangling the Inverse LDL-C-hemorrhagic Stroke Association in Chinese Adults with Hypertension: Findings from the Chinese Multi-Provincial Cohort Study.

Why lower low-density lipoprotein cholesterol (LDL-C) was associated with a decreased atherosclerotic cardiovascular disease (ASCVD) risk but an increased hemorrhagic stroke (HS) risk in hypertensive adults remains unclear. We examined whether the inverse LDL-C-HS association partly arises from its effect on ASCVD. We estimated separable effects of LDL-C on HS outside (i.e., separable direct effect) or only through its effect on ASCVD (i.e., separable indirect effect) in hypertensive adults from the Chinese Multi-provincial Cohort Study. We quantified such effects using numbers needed to treat (NNT) to prevent or cause an extra HS based on the restricted mean event-free time till a 25-year follow-up. LDL-C $<$ 70 mg/dL was not associated with an increased HS risk compared to LDL-C $\ge$ 70 mg/dL regarding total and separable direct effects. However, a small separable indirect effect (i.e., NNT to harm: 9722 participants) was noted and validated via a series of sensitivity analyses. Moreover, modified effects were observed, particularly in the 35-49-year age group, men, and those with SBP $\ge$ 140 mm Hg. These results suggest the inverse LDL-C-HS association in hypertensive adults is partly due to its effect on ASCVD. A better understanding of such associations would provide more enlightening into stroke prevention.

A single institution retrospective study of efficacy and complications perspective of Gamma Knife Radiosurgery for benign skull base meningioma: A 12-year follow-up

Background and Objectives: Gamma knife radiosurgery (GKRS) has established its role as an effective treatment modality for inaccessible, recurrent, and residual benign skull base meningioma. Therefore, it is necessary to study the outcome in the long term. The current retrospective study aims to analyze and report the clinical and radiological outcomes after long-term follow-up of GKRS for skull base meningiomas &gt;= 12 years. Patients and methods: The present study was conducted on 106 consecutive patients harboring benign skull base meningiomas treated by GKRS at our IMC center between 2005 and 2012 and was followed till the end of 2023. Results: After a median follow-up of 13 years (3.6-18 years), a tumor control rate was reported in 88.7% of patients (n 94/106). Recurrences and tumor progression occurred in 11.3% (n 12/106) at a median follow-up period of 5.4 years (3–10.3 years). The 3, 5-, 10-, 12-and 15-year actuarial tumor control rate was 100%, 95.3%, 89.7%, 88.7%, and 78.1% respectively. Conclusions: The current retrospective study provides a long-term 12-year follow-up and comprises one of the longest follow-up studies of GKRS-treated benign skull base meningiomas. The current series documents a persistent long-term high local tumor control and an acceptable low incidence of neurological deficits. Benign skull base meningioma volume variant at the time of GKRS is a statistically significance predictor factor for tumor control at long-term outcomes.