2-year Study Research Articles

Predictive value of insulin resistance metabolic score for cardiovascular disease in Chinese arthritis patients: a prospective cohort study.

Although patients with arthritis have significantly increased cardiovascular disease (CVD) risk, effective prediction tools remain limited. This study aimed to evaluate the predictive value of the Metabolic Score for Insulin Resistance (METS-IR) for CVD events among Chinese patients with arthritis. Using data from the China Health and Retirement Longitudinal Study (CHARLS), we conducted a 7-year prospective cohort study (2011-2018) involving 1,059 patients with arthritis. The primary exposure was baseline METS-IR, and the primary outcome was incident CVD. Multivariate Cox regression models were used to analyze the association between METS-IR and CVD risk, adjusting for demographic characteristics and lifestyle factors. After adjusting for confounding factors, each quartile increase in METS-IR was associated with a 36% increased risk of CVD (HR = 1.36,95%CI : 1.14-1.61, p< 0.001). Compared with the lowest quartile, the highest quartile showed a 63% increased risk (HR = 1.63,95%CI : 1.12-2.37, p< 0.05), demonstrating a significant dose-response relationship (p for trend < 0.05). METS-IR serves as an effective tool for predicting CVD risk among Chinese patients with arthritis, providing new strategies for early risk identification and prevention.

Incidence trends of ductal carcinoma in situ in New Zealand women between 1999 and 2022.

In New Zealand, BreastScreen Aotearoa (BSA), a biennial national breast screening programme, was implemented in 1998. This study examines the incidence trends of ductal carcinoma in situ (DCIS) in New Zealand women from 1999 to 2022. All women with a primary diagnosis of DCIS over the 24-year study period were identified from the New Zealand Cancer Registry and BSA records. Age-standardised incidence rates (ASIR), detection rates (ASDR) and average annual percent changes were calculated. The annual ASIR was 13.5 per 100,000 New Zealand women, and increased by 0.91% (95% confidence interval (CI): 0.26%, 1.66%) annually. Among women aged 45-69years during 2006-2022, the annual ASIR was 36.3 for programme-detected DCIS, increasing 1.29% (95%CI: 0.13%, 2.73%) per year, and 14.2 for non-programme-detected DCIS, with no significant changes over the study period. The programme-detected ASIRs were highest for Pacific (38.6), Asian (38.2), and Māori (38.0) women. The programme ASDR was 0.55 per 1000 women screened, with no significant changes over time, and was highest for Asian (0.69), and Māori and Pacific (both at 0.65) women. DCIS incidence increased in New Zealand women from 1999 to 2022, driven by an increase in screening participation, and varied by ethnicity.

Forensic pathology standards in China: a 30-year retrospective study.

China's forensic pathology standardization has accumulated more than 30 years of experience, but there is limited research summarizing the features and detailed information concerning these standards. In this paper, we collected documents on forensic pathology standards and statistically analyzed their types, effective scopes, drafting units, authorization departments, promulgation times, revision cycles, and other information. All of the standards information was obtained from standardization websites and databases. Since the first national standardization committee of forensic science established in 1991, a total of thirty-six forensic pathology standards have been published, including one national standard, thirty-one sector standards, and four enterprise standards. Among them, twenty-four standards were currently valid, while another twelve had been repealed. There were two management standards and thirty-four technical standards. The minimum revision cycle for standards was nine years, and the maximum cycle was twenty-three years. The standards system of forensic pathology had been primarily established, and the public welfare attributes of standardization were strengthened. However, some challenges still await positive actions, such as resolving the relative deficiencies of basic and management standards, satisfying the requirements for national standards, and advancing the delayed revisions of standards. In the future, we should continue to promote national standards for forensic pathology, actively absorb advanced international experience, strengthen the construction of basic and management standards, and fully encourage the flexibility, efficiency, and pioneer of standards dominated by associations, enterprises, and other organizations.

Health and Health Care Utilization Outcomes for Individuals With Traumatic Brain Injury: A 1-Year Longitudinal Study.

Traumatic brain injury (TBI) can result in new onset of comorbidities and limited studies suggest health care utilization following TBI may be high. Setting, Participants, Mean Measures, and Design: This study used 2018 and 2019 MarketScan Commercial Claims and Encounters data to examine differences in longitudinal health outcomes (health care utilization and new diagnoses) by various demographic factors (age, sex, U.S. region, intent/mechanism of injury, urbanicity, and insurance status) among individuals with and without a TBI in the year following an index health care encounter. Results show that within 1 year of the initial encounter, a higher percentage of patients with TBI versus without TBI had at least one outpatient visit (96.7% vs 86.1%), emergency department (ED) visit (28.5% vs 13.1%), or hospital admission (6.4% vs 2.6%). Both children (33.8% vs 23.4%) and adults (43.8% vs 31.4%) who sustained a TBI had a higher percentage of new diagnoses within 1 year compared to the non-TBI group. Additionally, individuals with a TBI had greater health care utilization across all types of health care settings (outpatient and inpatient), visits (ED visits and hospital admissions), and across all demographic factors (P <.001). These results may inform future research around the development of systems of care to improve longer-term outcomes in individuals with TBI.

Parkinson's disease and deep brain stimulation of the subthalamic nucleus (STN-DBS): long-term disease evaluation and neuropsychological outcomes in a 9-year matched-controlled study.

Matched-controlled long-term disease evaluation and neuropsychological outcomes derived from deep brain stimulation of the subthalamic nucleus (STN-DBS) in Parkinson´s disease (PD) are lacking, with inconsistent results regarding the cognitive impact of this procedure. Here we study the long-term effects associated to DBS comparing outcomes with a matched control group. A prospective observational study of 40 patients with PD with bilateral STN-DBS, with a mean follow-up of 9 (6-12) years was conducted. Disease evaluation was performed using the UPDRS-III, UPDRS-II, Hoehn-Yahr, and Schwab-England scales. Neuropsychological assessments were achieved utilizing the MMSE, DRS, RAVLT, BVRT, Stroop, and verbal fluency tests. A control group was used for comparison. Statistical analysis was performed with SPSSv.26. 40 patients were included, with a mean age of 62.8 ± 8.5 at the time of intervention. An improvement in motor symptoms of 48.6% (p < 0.001) and a reduction in LED of 58.6% (p < 0.001) was observed. No significant differences were observed in the MMSE (p = 0.414), DRS (p = 0.251), memory or interference assessments. A worsening in the construction subscale of DRS (p < 0.05) and in verbal fluency (phonemic and semantic) (p < 0.05) was observed. A head-to-head comparison showed significant differences between groups. An age ≤ 60 years was associated with a good long-term clinical prognosis (p = 0.019;OR = 6.75). STN-DBS is an effective and safe therapeutic option for the control of motor symptoms. However, it is associated with a selective deterioration in some cognitive functions in the long term. This study comprehensively evaluates STN-DBS in Parkinson´s disease in the long term, with findings that should be considered when indicating surgery in PD patients.

Association between dietary antioxidants, serum albumin/globulin ratio and quality of life in esophageal squamous cell carcinoma patients: a 7-year follow-up study

Association between dietary antioxidants, serum albumin/globulin ratio and quality of life in esophageal squamous cell carcinoma patients: a 7-year follow-up study

Long-term antibody trajectories after PPSV23 in elderly: Results from a 4-year follow-up study.

The 23-valent pneumococcal polysaccharide vaccine (PPSV23) is recommended for standalone or sequential use in the elderly in many countries to prevent pneumococcal disease, making it crucial to assess vaccine response and long-term persistence. We aimed to describe the trajectories of circulating antibody levels to the PPSV23 in the elderly following immunization. Eligible individuals aged 65 to 70years were enrolled and vaccinated with one dose of PPSV23. Blood samples were collected at baseline (day 0), 4-6weeks, one year, two years, three years, and four years after vaccination from November 2019 to December 2023. Serotype-specific IgG antibodies were measured for 7(4,6B,9V,14,18C,19F and 23F) out of the 23 vaccine serotypes. Group-based trajectory modeling (GBTM) was applied to identify distinct trajectories of IgG concentration at each visit after immunization. A total of 237 participants completed all six visits over the four-year follow-up period, and the geometric mean concentrations (GMC) of antibodies against the seven serotypes remained elevated above the baseline levels by the fourth year. Females and those with a body mass index (BMI) over 25 have generally higher antibody levels pre- and post-immunization across the seven serotypes, with serotypes 6B, 18C show significant difference in higher BMI individuals, and serotype 9V show significant difference in females after immunization. Based on GBTM, we identified two or three distinct trajectory types of IgG concentration changes across serotypes, with the exception of serotype 4, and we found that participants who showed a more rapid decline in antibody levels two years after vaccination had significantly higher baseline antibody levels. Pneumococcal IgG antibody levels persist for a minimum of four years post-vaccination; Our findings indicate that BMI, gender, and pre-vaccination antibody concentrations should be considered when developing vaccination and revaccination strategies in the elderly.

Associations of objectively measured physical activity and sedentary time with all-cause mortality in Japanese older adults: a 10-year prospective study

ObjectiveTo examine the associations of accelerometer-measured physical activity and sedentary time with all-cause mortality in older Japanese adults.MethodsA total of 1723 independent Japanese adults aged ≥65 years were followed from...

Effect of fertility desire-based service on HIV seroconversion among serodiscordant partners: A 12-year retrospective cohort study.

Fertility desire-based service guided by behavioral theory is a potential strategy to mitigate the HIV transmission risk, while related evidence remains scarce. We examined the long-term effect of theory-guided fertility desire-based services on HIV seroconversion between seropositive/seronegative partners in areas with high HIV prevalence and a cultural emphasis on fertility in China. We established a retrospective cohort by recruiting 8,653 seropositive partners with seronegative partners between January 1, 2009, and December 31, 2020, in Liangshan, China. The differences in HIV seroconversion between partners who received fertility desire-based services guided by the extended Information-Motivation-Behavioral Skills (IMB) model and those who did not were estimated, based on multivariable and inverse probability weighting (IPW) adjusted multivariable Cox regression models. Subgroup analysis was conducted based on participants' demographic and HIV-related characteristics. Among the 8,653 HIV-seropositive partners, 7,958 (92.0%) and their seronegative partners received fertility desire-based services. At the end of the 12-year follow up, 18 seronegative partners who did not receive fertility desire-based services experienced HIV seroconversion (incidence density: 7.4/1,000 person-years), while 98 seronegative partners receiving such services exhibited HIV seroconversion (3.4/1,000 person-years). Fertility desire-based services significantly reduced the risk of HIV seroconversion according to multivariable (HR=0.32, 95%CI: 0.19-0.53) and IPW-adjusted multivariable Cox regression models (HR=0.48, 95%CI: 0.27-0.84). The effect of fertility desire-based services was more pronounced in males and those above 40 years old. Fertility desire-based services based on the extended IMB model may help reduce the HIV transmission risk between seropositive/seronegative partners in areas with high HIV prevalence.

Long-term Clinical outcomes and Optimal Treatment Approaches of Degenerative Cervical Spondylosis: A 12-year Multicenter Retrospective Cohort Study.

A retrospective cohort study. To compare long-term outcomes and complications of cervical disc replacement (CDR) and anterior cervical discectomy and fusion (ACDF) with cage-plate constructs (CPC) and stand-alone (SA) cages in treating degenerative cervical spondylosis. ACDF is commonly used for cervical radiculopathy but may increase adjacent segment degeneration (ASD). CDR has gained popularity by preserving motion and potentially reducing ASD, while SA cages offer a simpler alternative to CPC. Despite widespread adoption, further research is needed to clarify the long-term outcomes and associated complications. A retrospective analysis was conducted on 1,146 patients who underwent cervical surgery between 2009 and 2012 at three Chinese hospitals, grouped into CDR (n=220), CPC-ACDF (n=540), and SA-ACDF (n=386). Primary outcomes included overall success rate and complications. Secondary measures were JOA, VAS, SF-36 scores, and imaging parameters. The CDR group exhibited a significantly higher overall success rate compared to CPC-ACDF and SA-ACDF groups. Dysphagia incidence immediately post-surgery was significantly lower in the CDR and SA-ACDF groups compared to CPC-ACDF. At the final follow-up, implant subsidence was lowest in the CDR group. Radiographic-ASD incidence was significantly lower in the CDR and SA-ACDF groups compared to CPC-ACDF, with SA-ACDF having the lowest rate of symptomatic-ASD. The reoperation occurred in 38 (7.0%) CPC-ACDF, 18 (4.7%) SA-ACDF, and 8 (3.6%) CDR patients. Despite a 65.5% incidence of heterotopic ossification (HO), CDR partially preserved angular range of motion. Multivariate logistic regression analysis suggested that SA-ACDF and CDR were protective factors against postoperative radiographic-ASD. Conditional nomograms demonstrated good predictive performance for symptomatic-ASD, supported by receiver operating characteristic and calibration curves. This study suggests that CDR provides similar clinical outcomes with fewer complications compared to ACDF. However, further research is needed to confirm these findings, particularly considering the variability between different CDR devices and potential for selection bias.

A Descriptive Analysis of the Seasonal Patterns of Bone Stress Injury Incidence in Division I Collegiate Distance Runners.

A bone stress injury (BSI) is a common overuse injury in collegiate athletes, particularly cross-country and track and field runners. Limited work describes the seasonality of BSIs or the differences in rates and anatomic locations of BSIs in collegiate runners. To describe seasonally related trends in anatomic locations of BSIs in National Collegiate Athletic Association (NCAA) Division I male and female middle- and long-distance runners. Descriptive epidemiological study. Data from a 7-year prospective study of 2 NCAA Division I cross-country and track and field programs characterized BSIs over the years 2013 to 2020. Femoral neck, pelvic, sacral, lumbar spine, and calcaneal BSIs were considered trabecular-rich. All remaining BSIs were classified as cortical-rich. Total athlete-years of follow-up were calculated by subtracting the number of days an athlete was unable to run from the number of total study participation days. Annual incidence rates were calculated by dividing the number of BSIs by the total athlete-years of follow-up for that year, and monthly incidence rates were calculated by dividing the number of BSIs in a given month by the total athlete-years of follow-up for that month. Participants included 221 collegiate distance runners (114 female, 107 male). There were 154 BSIs across 482 total athlete-years, resulting in an incidence rate of 32 BSIs per 100 athlete-years. The female BSI rate was more than double that of the male BSI rate: 45 versus 20 BSIs per 100 athlete-years, respectively. The highest monthly BSI rates occurred during competitive months, with the lowest monthly BSI rates occurring during noncompetitive months. Tibial and femoral shaft BSI rates peaked during the early competitive phases of each season, whereas metatarsal BSI rates remained relatively constant. Cortical-rich BSI rates varied by sex and seasonal phase, whereas trabecular-rich BSI rates remained relatively consistent. BSIs were common in collegiate distance runners, especially among female athletes, with higher rates during the competitive phases of the running season. Tibial and femoral shaft BSI rates were highest during the competitive phases and lowest during the noncompetitive phases, while metatarsal BSI rates remained consistent throughout the season. Cortical-rich BSI rates varied by seasonal phase and sex, whereas trabecular-rich BSI rates were relatively constant.

Association between weight-adjusted waist index and cognitive impairment in Chinese older men: a 7-year longitudinal study

Association between weight-adjusted waist index and cognitive impairment in Chinese older men: a 7-year longitudinal study

Functioning performance trajectory and its associated factors for people with disability—A 4-year national study

BackgroundHumans experience functioning difficulties in daily life, which are dependent on the interaction between health conditions and barriers in life. In general, functioning is an umbrella term and a dynamic concept. Thus, identifying the factors associated with long-term functioning would be beneficial to the development of specific health policies and quality of life for people with disabilities. However, previous studies are mainly cross-sectional ones, and fewer studies focus on the long-term effect of changes in functioning for people with disabilities. The current study aims to examine functioning performance trajectory and the associated factors for people with disabilities.MethodsA longitudinal study was conducted over four years, for which data were retrieved from the National Disability Eligibility Determination System in Taiwan. The assessment methods used are as follows: activity and participation rated using the WHO Disability Assessment Schedule 2.0 (with high scores indicating increased limitations in daily life), personal factors, body function and structure, and environmental factors. Statistical analysis was conducted using latent growth curve models.ResultsWe recruited 3,720 people with disabilities. We found that females, people with moderate and severe disability level, and those who were employed were associated with rapid increases in functioning scores every year. Conversely, improved social participation was linked to relatively slow increases in functioning scores regardless of the type of disability (p <.05).ConclusionsDetermining the factors associated with long-term functioning can serve as a reference for the development of health policies and improvement of quality of life for people with disabilities.

Hearing Loss as a Risk Factor for Dementia: A Nationwide 15-Year Follow-Up Cohort Study in Taiwan.

Although hearing loss is associated with dementia, the exact causal relationship between hearing loss and dementia remains unclear. Early detection and prevention of hearing loss are essential. In this study, data from the National Health Insurance Research Database (NHIRD) of Taiwan were used to monitor patients with hearing loss for 15 years to determine whether hearing loss leads to dementia. This retrospective matched-cohort study involved 208,570 individuals, divided into 41,714 patients with hearing loss and 166,856 controls matched by sex, age, and chronic diseases. Cox regression analysis was conducted on data obtained from the NHIRD for the period 2000-2015 to determine the hazard ratio (HR) associated with dementia. The percentage of patients with hearing loss who developed dementia was higher than that of the control group (18.67% vs. 14.10%). The onset age of dementia was younger in the hearing loss group (69.95 vs. 70.31 years, p = 0.001). Middle-aged individuals (45-65 years) with hearing loss were more likely to develop dementia compared with those without hearing loss (48.53% vs. 47.94%, p = 0.03). Compared with the controls, the patients with hearing loss were more likely to develop hyperlipidemia and stroke. In the patients with hearing loss, the adjusted HRs for Alzheimer's disease (AD), vascular dementia, and other types of dementia were significant. The patients were followed up for an average of 7.82 years. Compared with the controls, the patients with hearing loss exhibited a shorter mean time to dementia onset (5.21 vs. 5.49 years, p < 0.001). Hearing loss may increase the risks of AD, dementia, hyperlipidemia, and stroke. Therefore, health-care providers should closely monitor cardiovascular complications in patients with hearing loss.

Measuring social integration, treatment, and mortality after substance use treatment: methodological elaborations in a 20-year follow-up study

ObjectiveAlcohol and Other Drug (AOD) disorders cause substantial harm. Effective Substance Use Treatment (SUT) exists, but long-term outcomes remain inconclusive. This study used a 20-year prospective follow-up of 1248 service users entering SUT in Stockholm, Sweden, in 2000–2002 to elaborate on how different dimensions of long-term outcomes may be measured by register-based indicators. Baseline characteristics and attrition bias were explicated, and register-based outcomes were examined.ResultsRegister-based indicators are valuable, but they also have inherent limitations such as the lack of substance use data and inability to differentiate between un/met treatment needs and access. Significant variations in long-term outcomes were evident depending on which register-based indicator was used, and whether used in isolation or combinations. Six out of 10 service users were still alive after 20 years, but as many as 8 out of 10 of the survivors remained in treatment, and only two out of 10 had a stable economic situation. Hence, the register indicators identified only a few survivors, with stable economic and social situations, and without recent treatment contacts 20 years after treatment entry. The long-term outcomes were concerning and even more so when combining outcome dimensions.

Circulating growth differentiation factor-15 levels are associated with early echocardiographic signs of diastolic function impairment in the STANISLAS cohort: A 20-year follow-up study.

Early identification of healthy subjects prone to develop cardiac dysfunction may be instrumental to prevention strategies. Our study aimed to evaluate whether circulating levels of growth differentiation factor-15 (GDF-15) could predict adverse changes in echocardiographic indexes of cardiac structure and function in an initially healthy populational familial cohort with a long follow-up (STANISLAS cohort). We evaluated 1679 participants (49 ± 14 years, 48% males) included in the fourth visit (V4) of the STANISLAS cohort with available GDF-15 measurements (Olink proteomic analysis) and echocardiographic parameters. Among them, 1562 had also GDF-15 measurements at the first visit (V1) (18.2 ± 1.4 years before V4). We evaluated both prospective (GDF-15 at V1) and cross-sectional (GDF-15 at V4) associations between GDF-15 levels and echocardiographic variables. In adjusted analyses, higher baseline GDF-15 levels were associated with lower left ventricular (LV) end-diastolic volume and higher E/e' ratio nearly two decades later (both p ≤ 0.01). The cross-sectional analysis at V4 also found significant associations between GDF-15 and LV end-diastolic volume and higher E/e' ratio, further identifying significant associations with impaired LV strain. In the STANISLAS cohort, initial circulating GDF-15 levels were associated with echocardiographic signs of reduced LV size and increased filling pressure almost two decades later. This association was also confirmed by evaluating GDF-15 at the follow-up visit (V4). These findings suggest a potential role for GDF-15 as an easy screening and prognostic tool of diastolic dysfunction in the general population.

Scrub typhus in pregnancy: A 10-year multicenter study in resource-limited settings in China.

Despite its association with high mortality rates and negative fetal outcomes, large-scale epidemiological studies on scrub typhus (ST) during pregnancy remain scarce. We conducted a retrospective, multicenter study by collecting 260 pregnant women with ST in China across a 10-year time period to evaluate how clinical characteristics changed over this time and identify risk factors for poor fetal outcome. In total, 78.5% (n = 204) presented with pathognomonic eschars or ulcers, and 75.4% (n = 196) had Weil-Felix test, in which 46.4% (n = 91) had a titer of ≥1:160 for OXK. A higher proportion of patients with pneumonia (18.7% vs. 9.5%, p = 0.033) and a longer length of hospitalization (7 vs. 6 days, p = 0.007) were seen in laboratory confirmed cases than clinically diagnosed cases. Compared to patients in the second trimester, a higher miscarriage rate (64.5% vs. 15.0%, p < 0.001) was observed in the first trimester, and a lower fetal death/stillbirth rate (1.0% vs 18.7%, p < 0.001) and a higher prematurity rate (21.0% vs. 9.3%, p = 0.019) were observed in the third trimester. The use of chloramphenicol (5.7% vs. 15.5%, p = 0.016) and fetal death/stillbirth rate (3.1% vs. 12.8%, p = 0.01) were decreased, but there was no significant improvement in fetal outcome in the second 5 years (35.1% vs. 39.7%, p = 0.466). Over 1/3 (n = 90) had a poor fetal outcome, including 40.0% (n = 36) miscarriage, 23.3% (n = 21) fetal death/stillbirth and 36.7% (n = 33) preterm birth. The use of macrolides reduced the risk of a poor fetal outcome, while lower gestational age (GA) at the time of infection, pneumonia, leucopoenia, thrombocytopenia, and use of chloramphenicol were associated with a poor fetal outcome in univariate logistic-regression analysis, but only lower GA at the time of infection and pneumonia were independent risk factors for a poor fetal outcome on multivariate logistic-regression analysis with an odds ratio of 6.6 (95% CI 2.4-17.8, p < 0.001) and 3.1 (95% CI 1.3-7.6, p = 0.011). This is the largest number of cases of ST in pregnancy so far. Our findings indicate that this population have a high risk of poor fetal outcome, especially those with lower GA at the time of infection and those with pneumonia at the same time. Further studies are needed to investigate the correlation between antibiotics regimens for this population and fetal outcome.

Global Trends in Prevalence and Future Projections of Pelvic Organ Prolapse: A 30-year Epidemiological Study.

Pelvic organ prolapse (POP) is a widespread disease in women. Despite its significant prevalence, there is a lack of comprehensive global studies, emphasizing the urgent need for tailored prevention and treatment approaches. This study aims to examine the global burden of POP from 1990 to 2021 and project future trends using the GBD data. Data were collected from the GBD 2021 database. A Bayesian age-period-cohort (BAPC) model was used to analyze the trends and predict future burden, with age-standardized prevalence rate (ASPR) and years lived with disability (YLD) as key metrics. In 2021, the global ASPR and age-standardized YLD rate of POP were 2769.4 (95%UI 2299.2-3298.2)and 8.5 (95% UI 4.1-16.2) per 100,000 people, respectively. Both ASPR and YLD rate decreased between 1990 and 2021. The burden of POP is highest in low-SDI regions. The global prevalence of POP was highest in the 80+ age group, while the absolute number of cases reached its peak in the 55-59 age group. By 2036, the global population of POP patients will reach 156 million. Additionally, both the ASPR and AS-YLD rates of POP will continue to decline over the next 15years. While the global burden of POP decreased between 1990 and 2021, ASPRs in regions with low SDI remained high. With the gradual aging population, POP will continue to pose a significant burden on women's health and the social economy in the future. Strengthening global surveillance and prevention efforts for POP remains a critical challenge.

The effects of occupational aluminum exposure on blood pressure and blood glucose in workers - A longitudinal study in northern China.

Trace element and metal exposure is closely related to the occurrence of chronic diseases, particularly affecting blood pressure and blood glucose. Current studies suggest that heavy metal exposure is a risk factor for hypertension and diabetes. Aluminum can enter the human body through daily life and occupational exposure from food, environment, drugs, and other sources, affecting the cardiovascular, endocrine, and other systems. Therefore, it is significant to observe the effect of aluminum on blood pressure and blood glucose in workers with high concentration. In this study, electrolytic workers naturally exposed to high concentrations of aluminum were selected. The aim of the 5-year cohort study was to investigate the effects of continuous occupational aluminum exposure on blood pressure and blood glucose in workers and to assess the risk of potential cardiovascular and metabolic diseases due to heavy metal exposure. In 2014, 183 participants from an electrolysis workshop at an aluminum plant in Shanxi were enrolled. Inductively coupled plasma mass spectrometry (ICP-MS) was performed to determine the plasma aluminum (P-Al) concentration of the workers and measured their blood pressure and glucose levels. At the 2019 follow-up, all parameters were measured again in the same workers. The relationship of the P-Al concentration with blood pressure and glucose levels was assessed using generalized linear regression, and risks of developing hypertension and hyperglycemia (diabetes or pre-diabetes) due to Al exposure were assessed using binary logistic regression. Dose-response relationships between average annual rates of change in P-Al and average annual rates of change in blood pressure and blood glucose were analyzed using RCS. The relative risk (RR) and attributable risk (AR) were also calculated. Generalized linear regression showed that the average annual rate of change in P-Al concentration was positively correlated with the annual rates of change in SBP, DBP, and blood glucose levels, with each e-fold increase in P-Al concentration increasing the annual rates of change in SBP and DBP by 3.55 % (P < 0.01) and 3.43 % (P = 0.03), respectively. Binary logistic regression showed that as the average annual rate of change in P-Al concentration (categorical variable) increased, the risk of developing hypertension increased (Ptrend < 0.05). The RCS results showed that the relationship between the average annual rate of change in P-Al and the average annual rate of change in SBP was a showed a dose-response relationship (P for overall association<0.05). RR and AR increased with increasing P-Al concentration in both hypertensive and diabetic patients. Persistent occupational aluminum exposure is associated with elevated blood pressure levels in workers and increases the risk of developing hypertensive disorders.

Prospective Fumarate Hydratase Tumor Predisposition Syndrome Screening in Patients With Uterine Smooth Muscle Tumors: Age, Morphology, Fumarate Hydratase/S-(2-succino) Cysteine Immunohistochemistry, and Germline Testing.

Fumarate hydratase tumor predisposition syndrome (FHTPS) is caused by germline fumarate hydratase (FH) pathogenic variants (PVs). Most women with FHTPS develop FH-deficient (FHD) uterine leiomyomas (ULs), which arise 10 to 15 years earlier than aggressive FHD-renal cell carcinoma. We evaluate a previously proposed FHTPS screening strategy for women with ULs. This 5-year, prospective and retrospective study performed FH and later S-(2-succino) cysteine immunohistochemistry (IHC) on all uterine smooth muscle (USM) tumors in patients 40 (later ≤30) years or younger and on all USM tumors with suggestive FHD morphology regardless of age. Patients with FHD tumors by IHC were referred to genetic counseling. Of 840 USM tumors, 112 FHD-tumors by IHC (13%) were identified, all with suggestive FHD-morphology; 44 patients (39%) underwent germline testing, and 15 harbored germline FH PVs (34.1% of germline tested, 13.4% of all FHD-tumors). While FHD tumors were seen across a wide age range (24 to 73 y), those with germline FH PVs were significantly younger (median 33 vs 44 years wild-type, P = 0.0032). Few (12.5%) patients ≥40 and no patients ≥50 had a germline FH PV, whereas a majority (60%) of patients <40 (86% of those <30) had a germline FH PV. We demonstrate that previously proposed resource-conscious screening involving morphology and IHC is effective for identifying women with FHTPS. We provide prospective data confirming patients presenting with FHD-ULs over age 50 are unlikely to harbor germline FH PVs and argue that for germline testing without consideration of other factors, a threshold of younger than 50 years may be appropriate.