2-year Study Research Articles

Attention-Deficit/Hyperactivity Disorder and Subsequent Trauma Exposure: The Mediating Role of Deviant Peer Affiliation.

Individuals with ADHD symptoms are at an increased risk of lifetime trauma exposure. However, research has yet to fully examine whether symptoms of ADHD function as a temporal risk factor for experiencing trauma and specific mechanisms that may explain the association between symptoms of ADHD and trauma exposure. Two constructs that may account for the relation between ADHD symptoms and trauma are deviant peer association and neighborhood disadvantage. The present study sought to 1) elucidate the temporal nature of ADHD symptoms and exposure to trauma and 2) examine whether peer deviancy and/or neighborhood disadvantage mediate the relation between childhood ADHD symptoms and subsequent trauma exposure across a 20-year longitudinal cohort study. Participants (N = 616) were predominantly Black/African American (86%; Male n = 389) from an urban school district. Using structural equation modeling, total trauma exposures during young adulthood (Years 17-20) were regressed on parent- and teacher-rated ADHD symptoms in Grade 1 (Year 1). A significant indirect path from ADHD symptoms to trauma exposure through deviant peer affiliation (Year 16) indicated that having childhood ADHD symptoms predicted deviant peer affiliation 16years later, which in turn predicted greater exposures to traumatic events during young adulthood, controlling for neighborhood disadvantage. Neighborhood disadvantage was not a significant mediator when accounting for peer deviancy. Taken together, findings contribute to a limited body of research that utilizes a prospective design to examine the association between childhood ADHD symptoms and trauma exposure in young adulthood among Black/African American youth. Potential targets for intervention are proposed.

Predicting diabetes in adults: identifying important features in unbalanced data over a 5-year cohort study using machine learning algorithm

BackgroundImbalanced datasets pose significant challenges in predictive modeling, leading to biased outcomes and reduced model reliability. This study addresses data imbalance in diabetes prediction using machine learning techniques. Utilizing data from the Fasa Adult Cohort Study (FACS) with a 5-year follow-up of 10,000 participants, we developed predictive models for Type 2 diabetes.MethodsWe employed various data-level and algorithm-level interventions, including SMOTE, ADASYN, SMOTEENN, Random Over Sampling and KMeansSMOTE, paired with Random Forest, Gradient Boosting, Decision Tree and Multi-Layer Perceptron (MLP) classifier. We evaluated model performance using F1 score, AUC, and G-means—metrics chosen to provide a comprehensive assessment of model accuracy, discrimination ability, and overall balance in performance, particularly in the context of imbalanced datasets.Resultsour study uncovered key factors influencing diabetes risk and evaluated the performance of various machine learning models. Feature importance analysis revealed that the most influential predictors of diabetes differ between males and females. For females, the most important factors are triglyceride (TG), basal metabolic rate (BMR), and total cholesterol (CHOL), whereas for males, the key predictors are body Mass Index (BMI), serum glutamate Oxaloacetate Transaminase (SGOT), and Gamma-Glutamyl (GGT). Across the entire dataset, BMI remains the most important variable, followed by SGOT, BMR, and energy intake. These insights suggest that gender-specific risk profiles should be considered in diabetes prevention and management strategies. In terms of model performance, our results show that ADASYN with MLP classifier achieved an F1 score of 82.17 ± 3.38, AUC of 89.61 ± 2.09, and G-means of 89.15 ± 2.31. SMOTE with MLP followed closely with an F1 score of 79.85 ± 3.91, AUC of 89.7 ± 2.54, and G-means of 89.31 ± 2.78. The SMOTEENN with Random Forest combination achieved an F1 score of 78.27 ± 1.54, AUC of 87.18 ± 1.12, and G-means of 86.47 ± 1.28.ConclusionThese combinations effectively address class imbalance, improving the accuracy and reliability of diabetes predictions. The findings highlight the importance of using appropriate data-balancing techniques in medical data analysis.

Deep Learning-based 12-Lead Electrocardiogram for Low Left Ventricular Ejection Fraction Detection in Patients

BackgroundReduced left ventricular ejection fraction (LVEF) initiates heart failure, and promptly identifying low ejection fraction is crucial for managing progression and averting mortality. This study developed an artificial intelligence-enabled electrocardiogram (AI-ECG) algorithm to identify patients with low ejection fraction and predict LVEF values. MethodsThe ECG data were used as input, and the algorithm generated the probability of the patient suffering a low ejection fraction as well as estimating the LVEF value. A 5-year follow-up study on a group of individuals who initially had normal LVEF values was also performed. Furthermore, external validation of the algorithm performance was conducted using the Medical Information Mart for Intensive Care (MIMIC-IV) database. ResultsThe algorithm's performance on the test set yielded an area under the curve (AUC) of 0.965 for detecting LVEF ≤ 50%. The algorithm had an accuracy of 92.8%, sensitivity of 88.8%, and specificity of 92.9%. For LVEF regression, the method showed a mean absolute error (MAE) of 5.28 (95% CI: 5.23 - 5.33) for the testing set. Additionally, the algorithm obtained an AUC value of 0.848 and an MAE value of 9.56 during external validation. Patients with false-positive results had a significantly greater likelihood of developing a low ejection fraction compared to patients who received true negative results (26.2% vs. 2.0%, P < 0.0001). ConclusionsThe AI-ECG algorithm is capable of identifying low ejection fraction in patients with high accuracy. The AI-ECG algorithm is an efficient, prompt, and cost-effective screening tool for early heart failure.

Developmental cascades from maternal depressive symptoms in childhood to adolescents' friendship quality: A 13-year longitudinal study.

Adolescent friendships of positive quality promote well-being for decades to come. But what impedes the development of positive friendship quality? The present study examined whether maternal depressive symptoms during early childhood predict children's friendship quality into adolescence, and whether observed negative parenting behavior and children's earlier friendship quality, social skills, and their own depressive symptoms in middle childhood mediate these associations. We used six waves of data from a prospective longitudinal community sample (N = 396). The study followed children and their mothers across 13 years from child ages 2-15 years (52% female, 67% White, 26% Black), collecting multi-informant data (from mothers, children, teachers, and behavioral observations). The significance of indirect effects was estimated with structural equation modeling. Exposure to high levels of maternal depressive symptoms in early childhood (child ages 2-5 years) was negatively correlated with children's later adolescent friendship quality (at age 15). Structural equation models revealed that this association was mediated by children's poorer social skills (age 7) and friendship quality (age 10). Negative parenting behavior and children's depressive symptoms did not mediate this association. Maternal depressive symptoms have downstream associations with children's friendship quality into adolescence, including via children's social skills. Promoting the social skills of children exposed to maternal depressive symptoms could have long-term positive effects. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Sex differences in the relationship of intraindividual difference in estimated glomerular filtration rate by cystatin C and creatinine and depressive symptoms among middle-aged and older adults in China

BackgroundThe estimated glomerular filtration rate based on cystatin C (eGFRcys) and creatinine (eGFRcr) may differ substantially within an individual. The clinical implications of these differences (eGFRdiff) for depressive symptoms risk are unknown and whether it differed by sex are also unknown. MethodsThe prospective cohort study enrolled 3343 participants aged ≥45 years from the 2011–2020 waves of the China Health and Retirement Longitudinal Study. The eGFRdiff was calculated by eGFRcys minus eGFRcr at baseline. Depressive symptoms were measured by the ten-item Center for Epidemiologic Studies Depression Scale (CESD). Unadjusted and adjust logistic regression models were used to investigate the relationship between eGFRdiff and depressive symptoms. Results1628 (47.3 %) females and 1815 (52.7 %) males were analyzed in the present study. When considering eGFRdiff as a continuous variable, multivariate logistic regression analysis showed that higher eGFRdiff was associated with reduced depressive symptoms in females (OR = 0.993, 95%CI 0.985–0.999, p-value = 0.032), not in males (OR = 0.996, 95%CI 0.988–1.003, p-value = 0.280). The associations remained similar when comparing individuals across different eGFRdiff categories. ConclusionsIn this 9-year follow-up cohort study, baseline eGFRdiff was negatively associated with depressive symptoms among community-dwelling middle-aged and older females, but not males. Monitoring eGFRdiff could have clinical utility in identifying the risk of accelerated depressive symptoms progression in females.

Gaucher disease in Brazil: a comprehensive 16 year retrospective study on survival, cost, and treatment insights

BackgroundGaucher’s disease (GD), a lysosomal storage disorder, poses significant treatment challenges. This 23-year study assesses survival rates and treatment efficacy in Brazilian GD patients, integrating data from a 16-year cohort (2000–2015) and the TABNET/DATASUS medicines distribution data (1999–2022).ObjectiveTo investigate the survival of GD patients in Brazil, identifying key risk factors and evaluating the impact of treatments funded by the Brazilian National Health System (SUS).MethodologyA 16-year retrospective cohort study was conducted using the National Database of SUS. Patients diagnosed with GD and treated with Enzyme Replacement Therapy (ERT) or Substrate Synthesis Inhibition (SSI) from 2000 to 2015 were included. Survival analysis was performed using Kaplan-Meier method and Cox proportional hazards model. The data from TABNET/DATASUS system from 1999 to 2022 was used to assess the trend in drug distribution beyond the main cohort.ResultsThe study included 1,234 patients. Survival rates at 5 and 10 years were 93.2% and 88.5%, respectively, with age and comorbidities like diabetes, cardiovascular diseases, and Parkinson’s disease significantly affecting survival. Patients who received doses lower than DDD (n = 880) demonstrated a survival probability of 91.8%. In contrast, those with doses equal to the DDD (n = 15) showed a 100% survival probability, as no events were observed in this group. The greater than DDD group (n = 339) exhibited a survival probability of 81%. A log-rank test indicated a borderline statistical significance (p = 0.058) in the survival distributions among the different DDD adherence, with the lower dose group showing a favorable trend.ConclusionThis study provides insights into the survival rates and associated risk factors for GD patients in Brazil, contributing to the global understanding of GD and its management. While we acknowledge the inherent limitations of relying largely on electronic medical records and categorical codes, our findings underscore the need for early diagnosis, timely initiation of treatment, effective management of comorbidities, and personalized dosing strategies to improve patient outcomes. Future studies should aim to incorporate clinical verification of electronic data to further enhance the reliability and applicability of these findings.

Evaluating Pericardiectomy Outcomes and Determinants; an 8-Year Retrospective Study at Tertiary Teaching Hospitals in Ethiopia

&amp;lt;i&amp;gt;Background&amp;lt;/i&amp;gt;: Constrictive pericarditis has a variety of etiologies which leads to severe symptoms and heart failure which affects the quality of life. So far the main modality of treatment is pericardiectomy. &amp;lt;i&amp;gt;Objective&amp;lt;/i&amp;gt;: The aim of this research was to know pericardiectomy outcomes and determinants among constrictive pericarditis patients who were operated at Tikur Anbessa Specialized Hospital from 2014 - 2022. &amp;lt;i&amp;gt;Methods&amp;lt;/i&amp;gt;: A retrospective study was done among 65 patients. Data was presented using frequencies with percentages, mean (±standard deviation) and/ or median (interquartile range) as required. Perioperative mortality and complications were summarized using incidence density with 95% confidence interval (CI). &amp;lt;i&amp;gt;Result&amp;lt;/i&amp;gt;: Most patients were in their 20s (53.8%) and where male are (84.6%). The commonest presenting symptom was shortness of breath (100%), fatiguability (96.9%), and coughs (66.2%). The median time of presentation was 12.3 months (IQR, 7.0-25.5). There were also cases with clinical symptoms of tuberculosis (13.8%). The etiology of constrictive pericarditis was infectious in 83.1% of cases. The mean length of surgery was 3.3 ± 0.6 hours. The median duration of hospital stay is 9.0 days (IQR, 7.0-12.0). The incidence rate (IR) of perioperative death was 7.9 per 1000 person-days (PD) of observation (94% CI = 3.3 – 19.2) and the incidence rate of complication was 4.8 per 1000 PD (95% CI = 1.5 -14.9). &amp;lt;i&amp;gt;Conclusion&amp;lt;/i&amp;gt;: Pericardiectomy is the best treatment for patients with constrictive pericarditis. The majority of patients had a good outcome, with an improvement in symptoms and functional status. The mortality rate was low, and the complication rate was acceptable. However, this study is based on relatively small sample size, and it is a retrospective study from a single center. Hence, further prospective studies are needed to confirm the findings of this study.

Comparative Analysis of Early versus Late Surgical Intervention for Lumbosacral Hemivertebra: A Minimum 2-Year Follow-up Retrospective Study

Lumbosacral hemivertebra (LSHV) is a complex and unique congenital spinal deformity characterized by early severe trunk imbalance and progressive compensatory curve. Previous studies have proved the efficiency of posterior LSHV resection. However, the optimal timing for surgical intervention of LSHV still remains controversial. Few studies compare the surgical outcomes in patients of different age groups. To evaluate the influence of posterior-only LSHV resection surgery timing on clinical and radiographic results. Retrospective analysis. We retrospectively analyzed 58 LSHV patients undergoing posterior-only LSHV resection with short-segment fusion at our institution between 2010 and 2020, with a mean follow-up of 7.5 years. The following data were observed for all cases: patient demographics, clinical outcomes measured by operating time, intraoperative blood loss, complications, and Health-Related Quality of Life, radiographic parameters included Cobb angles, trunk shift and sagittal spinal parameters. From 2010 to 2020, a consecutive series of 58 LSHV patients treated by posterior LSHV resection with short segmental fusion were investigated retrospectively, with a 7.5-year average follow-up period (ranging from 2.0 to 19.5 years). Patients were stratified into two groups based on the timing of surgery: Group E (≤6 years old, representing the early-surgery) and Group L (>6 years old, representing the late-surgery). Radiographic assessments included pre- and postoperative measurements of main scoliosis, compensatory scoliosis, trunk shift, and sagittal balance parameters. Operative data, peri-operative complications and SRS-22 questionnaires were also collected. Compared to Group L, Group E exhibited a lower intraoperative blood loss (P<0.001), higher final main curve correction rate (P=0.037), smaller post-op compensatory curve (P=0.031), higher sagittal vertical axis correction rates at immediate post-op (P=0.045) and last follow-up (P=0.027), and lower implant failure complications incidence (P=0.006). This study suggested that early surgical intervention in LSHV patients can achieve better correction outcomes, while reducing blood loss and postoperative complications in a large-scale cohort.

Germ Cell Neoplasms of Sacrococcygeal Region: Clinical Characteristics, Outcomes and Analysis of Recurrence after Treatment; A Comprehensive 20-Year Single Center Study

Germ Cell Neoplasms of Sacrococcygeal Region: Clinical Characteristics, Outcomes and Analysis of Recurrence after Treatment; A Comprehensive 20-Year Single Center Study

Trend in Prevalence of Intestinal Parasitic Infections among Students at Oda Bultum University: A 5-year Retrospective Study

Trend in Prevalence of Intestinal Parasitic Infections among Students at Oda Bultum University: A 5-year Retrospective Study

Total versus subtotal tonsillectomy for recurrent tonsillitis: 5-year follow up of a prospective randomized noninferiority clinical trial.

In long-term follow-up, it remains uncertain whether tonsillectomy, a procedure associated with significant comorbidity, can be substituted with partial tonsillectomy in patients with recurrent tonsillitis. This paper is to present the 5-year follow-up data of our previous study titled "Total versus subtotal tonsillectomy for recurrent tonsillitis-a prospective randomized noninferiority clinical trial." The underlying study was performed as single-blinded prospective noninferiority procedure in patients with recurrent chronic tonsil infection, where one side was removed completely (tonsillectomy) and the other side partially (intracapsular/partial tonsillectomy). Five years after surgery, we collected data on the frequency of tonsillitis in the first, second, third, fourth, and fifth year post-surgery. We obtained assessments from patients, their ENT physicians, and general practitioners separately. To assess the impact of surgical therapy on overall quality of life, we employed the Glasgow Benefit Inventory (GBI). Out of the 111 patients initially included in the years 2015-2018, 79 were eligible for the 5-year follow-up, representing a 71% follow-up rate. The mean follow-up time was 60months. Notably, during the first 12months post-surgery, no cases of bacterial inflammation were observed in the remaining tonsillar tissue following partial tonsillectomy, suggesting noninferiority compared to total tonsillectomy. This effect remained consistent over the 5-year study period. GBI results indicate that both total and partial tonsillectomy positively impact the physical and mental health of patients with recurrent tonsillitis. Considering that partial tonsillectomy is associated with less pain and reduced postoperative bleeding, it may emerge as a potential replacement for total tonsillectomy as the standard method in the future.

Gender-related epidemiological characteristics of cauda equina syndrome caused by disc herniation: a 10-year study in Zenica-Doboj Canton, Bosnia and Herzegovina

Introduction: Aim of this study is to analyze gender-related epidemiological characteristics of cauda equina syndrome (CES) in Zenica-Doboj Canton in 10 years period. Methods: The study was conducted in the Zenica-Doboj Canton, and data were obtained from the time period between 2012 to 2022. The study included a total sample of 1709 patients diagnosed with disc herniation who underwent surgical decompression. In total, 48 patients developed cauda equine syndrome (CES). Results: The analysis unveiled noteworthy gender disparities, with male predominance (79.2% vs. 20.8%, p&lt;0.001) and varying employment distributions (males: 23.7% unemployed, 63.2% employed, 13.1% retired; females: 40.0% unemployed, 20.0% employed, 40.0% retired, p&lt;0.001). The calculated OR for 2012-2022 was 2.969 (95% CI: 1.576-5.593, p=xxx), signifying a substantial gender-incidence relationship for CES. CES-I incidence ranged 0.80-1.60/100,000 and CES-R ranged 0.25-0.83/100,000. Highest CES incidence was 4.17/100,000 (2015); the lowest was in 2019 with no CES-R cases reported. Male incidence peaked at 2.64/100,000 (2018), and the lowest was 1.06/100,000 (2013, 2017). For females, the highest was 1.17/100,000 (2018, 2021), with no cases reported in certain years. The affected level demonstrated gender differences, with L4/L5 prevalence in males (47.4%) and L3/L4 in females (50%, p=0.165). Conclusion: This study revealed a higher incidence of CES in males compared to females in the Zenica-Doboj Canton. The heterogenicity of data regarding CES occurring due to the lumbar disc herniation is significant. This indicates a clear need for additional research and epidemiological studies that would highlight the population of patients that have higher risk of CES onset.

Clinical features, hemorrhage risk and epilepsy outcomes of familial cerebral cavernous malformation: A 20-year observational pragmatic single-center study

IntroductionFamilial Cerebral Cavernous Malformations (fCCMs) are rare, hereditary conditions characterized by multiple central nervous system lesions. Despite their rarity, CCMs can cause significant clinical challenges when symptomatic, manifesting as seizure and symptomatic hemorrhage (CASH). Guidelines suggest neurosurgical intervention for symptomatic or previously symptomatic lesions, while conservative management is recommended for new-onset epilepsy. However, the natural history and optimal management remain unclear, necessitating further research. ObjectiveThis study aims to provide a comprehensive analysis of the clinical features, hemorrhage risk, and epilepsy outcomes in fCCM patients over an extended follow-up period, offering a more precise estimate of CASH and epilepsy rates in this population. MethodsThis retrospective longitudinal cohort study included fCCM patients enrolled from 2001 to May 2024. Data collected included demographic information, new neurological symptoms, symptomatic hemorrhages, seizures, and modified Rankin Scale (mRS) scores. Incidence rates of first symptomatic events and Kaplan-Meier survival curves were calculated, with logistic and Cox-proportional hazard regression models used to evaluate outcomes. ResultsA total of 47 patients were included in this study, with a mean age at diagnosis of 37.51 years. At diagnosis, 68 % were symptomatic, with 30 % having CASH and 36 % experiencing seizures without CASH. During a median follow-up of 126.0 months (interquartile range, 110.5 months), 17 % had a new CASH event, 20 % had seizures without CASH, and 60 % remained asymptomatic. The bleeding rate was 1.02 % per patient-year, with new focal neurological symptoms at 2.045 per 1000 patient-years and new CASH at 10.225 per 1000 patient-years. Most patients maintained minimal or no disability (mRS 0 or 1). Presenting with epilepsy at baseline significantly increased the odds of future seizures (OR 18.13, p = 0.001). ConclusionThis study highlights the complex presentation and progression of fCCMs, emphasizing the necessity for long-term monitoring. Baseline epilepsy is a significant predictor of future seizures, underscoring the need for individualized management strategies. Future research with larger cohorts and standardized criteria is essential to refine the understanding and management of fCCMs.

Effects of Water Immersion Versus Epidural as Analgesic Methods during Labor among Low-Risk Women: A 10-Year Retrospective Cohort Study

Background: Adequate pain relief during childbirth is a very important issue for women and healthcare providers. This study investigates the effects on maternal and neonatal outcomes of two analgesic methods during labor: water immersion and epidural analgesia. Methods: In this retrospective observational cohort study at a first-level hospital, in Spain, from 2009 to 2019, 1134 women, low-risk singleton and at term pregnancy, were selected. Among them, 567 women used water immersion; 567 women used epidural analgesia for pain control. Maternal outcomes included mode of birth and perineum condition. Neonatal outcomes included 5 min Apgar score, umbilical cord arterial pH, and Neonatal Intensive Care Unit admissions. Chi-square tests and Mann–Whitney U tests, together with their effect sizes (Cramer’s V, odds ratio, and Cohen’s d) were used to test the main hypotheses. Results: Spontaneous vaginal birth was almost 17 times more likely in the water immersion group (OR = 16.866 [6.540, 43.480], p &lt; 0.001), whereas the odds of having a cesarean birth were almost 40 times higher in the epidural group (OR = 39.346 [3.610, 429.120], p &lt; 0.001). The odds of having an intact perineum were more than two times higher for the water immersion group (OR = 2.606 [1.290, 5.250], p = 0.007), whereas having an episiotomy was more than eight times more likely for the epidural group (OR = 8.307 [2.800, 24.610], p &lt; 0.001). Newborns in the water immersion group showed a better 5 min Apgar score and umbilical cord arterial pH and lower rates in admissions at the Neonatal Intensive Care Unit. Conclusions: Women choosing water immersion as an analgesic method were no more likely to experience adverse outcomes and presented better results than women choosing epidural analgesia.

Quantitative assessment of interplay between urbanization dynamics and land surface temperature variations using generalized additive model coupled PDP for sustainable urban planning and management.

The mountainous region of Asir is experiencing rapid and unsystematic urbanization leading to an increase in land surface temperatures (LST), which poses a challenge to human well-being and ecological balance. Therefore, it is necessary to study the interaction between land use and land cover (LULC)-induced urbanization and LST using advanced geostatistical techniques. In addition, understanding the urbanization process and urban density is essential for effective urban planning and management. The aim of this study was to investigate the interaction between the urbanization process, urban density and the associated LST. Using the Random Forest Algorithm, LULC mapping was conducted for the years 1990, 2000 and 2020. Metrics such as land cover change rate (LCCR), land cover index (LCI), landscape expansion index (LEI), mean landscape expansion index (MLEI) and area-weighted landscape expansion index (AWLEI) were used to understand urbanization processes and LULC changes. Convolutional kernels were used to model urban density, and the mono-window algorithm was applied to analyse LST in the selected years. In addition, the study assessed the Surface Urban Heat Island (SUHI) contribution index to LULC and used Generalized Additive Models (GAMs) in conjunction with Partial Dependence Plots (PDPs) to understand the relationship between urbanization processes, urban density and LST. In a detailed 30-year study, the application of the RF algorithm showed significant shifts in LULC with an overall validation accuracy of over 85%. Urban areas grew dramatically from 69.40 km2 in 1990 to 338.74 km2 in 2020, while water areas decreased from 1.51 to 0.54 km2. Dense vegetation increased from 43.36 to 52.22 km2, indicating positive ecological trends. The LST analysis showed a general warming, with the mean LST increasing from 40.51°C in 1990 to 46.73°C in 2020 and the highest temperature category (50-60°C) increasing from 0.78 to 33.35 km2. The built-up area of cities tripled between 1990 and 2020, with the Landscape Expansion Index reflecting significant growth in suburban areas. The modeling of urban density shows increasing urbanization in the centre, which will expand significantly to the east by 2020. The contribution of LULC to LST and the Urban Heat Island (SUHI) effect was evident, with built-up areas showing a constant temperature increase. GAMs confirmed a statistically significant relationship between urban density and LST, with different effects for different types of urban expansion. This comprehensive study quantitatively sheds light on the complicated dynamics of urbanization, land cover change and temperature variation and provides important insights for sustainable urban development.

Changing Clinical Presentation of Pediatric Differentiated Thyroid Cancer in Poland: A Retrospective Cohort Study Spanning 45 Years.

Background: Differentiated thyroid carcinoma (DTC) in children is uncommon; clinical presentation over recent decades is incompletely characterized. Methods: This retrospective cohort study analyzed demographic and disease characteristics of consecutive juveniles with DTC treated from 1970 to 2015 at Poland's largest pediatric DTC referral center, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice, who had available records. Sex, age, histopathological characteristics, and DTC stage were documented. We aimed to identify changes in these variables over time and independent risk factors for lymph node or distant metastases. Trends in these variables were assessed using the Cochran-Armitage test and Spearman correlation. Multivariable logistic regression was performed to identify risk factors associated with lymph node or distant metastases. Results: 475 of 479 patients (99.2%) were included in the analysis; roughly half were age ≥15 years, 10%, <10 years. Papillary thyroid carcinoma (PTC) represented 88% of cases and follicular thyroid carcinoma (FTC) 11%. Tumors ≤2 cm constituted 56% of cases with relevant data; those >4 cm accounted for 12%. Multifocality was observed in 37% and extrathyroidal invasion in 22%. Lymph node metastases were noted in 59% and distant metastases in 16%. Over the observation period, significant trends among new cases included: increased proportion of adolescents >15 years; increased frequency of tumors ≤2 cm, decreased multifocality rates, and increased proportion of PTC versus FTC. Extrathyroidal invasion rates remained appreciable throughout, ranging from 17 to 28% during the 5-year study subperiods after 1990. Lymph node metastases significantly increased in frequency in the central neck, remaining consistently common in lateral sites; presence of distant metastases significantly decreased. In multivariable analysis, multifocality, extrathyroidal invasion, and tumor size were independently associated with lateral lymph node metastases and multifocality, larger tumor size, and N1b metastases with distant spread. Conclusions: Our observations of a rising proportion of diagnoses in adolescence, reductions in primary tumor size, and decreased frequency of multifocality and distant metastases may reflect increased detection of patients with less aggressive DTC at earlier disease stages. Nonetheless, we found persistently substantial rates of locoregionally advanced disease features (multifocality, extrathyroidal invasion, and lymph node metastases), which multivariable analyses suggested have significant associations with lateral lymph node and/or distant metastases.

Baseline and Longitudinal MRI Markers Associated With 16-Year Mortality in Patients With Cerebral Small Vessel Disease.

Information on whether small vessel disease (SVD) reduces life expectancy is limited. Moreover, the excess mortality risk attributed specifically to SVD compared with controls from the general population has not been evaluated. This study aimed to investigate the baseline and progression of MRI markers of SVD associated with mortality in a 16-year follow-up cohort study and to determine the excess long-term mortality risk of patients with SVD. Participants with SVD from the Radboud University Nijmegen Diffusion Tensor and Magnetic Resonance Imaging Cohort (RUN DMC) study (with MRI assessments in 2006, 2011, 2015, and 2020) were followed until their death or December 1, 2021. Adjusted Cox regression analyses and linear mixed-effect regression models were used to investigate the association between MRI markers of SVD and mortality. The excess mortality risk of SVD was calculated by comparing mortality data of the RUN DMC study with the general population matched by sex, age, and calendar year. 200 of 503 (39.9%) participants died during a follow-up period of 15.9 years. Cause of death was available for 182 (91%) participants. Baseline white matter hyperintensity volume (HR 1.3 per 1-SD increase [95% CI 1.1-1.5], p = 0.010), presence of lacunes (1.5 [95% CI 1.1-2.0], p = 0.008), mean diffusivity (HR 1.1 per 1-SD increase [95% CI 1.1-1.2], p = 0.001), and total brain volume (HR 1.5 per 1-SD decrease [95% CI 1.3-1.9], p < 0.001) were associated with all-cause mortality after adjusting for age, sex, and vascular risk factors. Total brain volume decrease over time was associated with all-cause mortality after adjusting for age, sex, and vascular risk factors (HR 1.3 per 1-SD decrease [95% CI 1.1-1.7], p = 0.035), and gray matter volume decrease remained significant after additionally adjusting for its baseline volume (1.3 per 1-SD decrease [1.1-1.6], p = 0.019). Participants with a Fazekas score of 3, presence of lacunes, or lower microstructural integrity had an excess long-term mortality risk (21.8, 15.7, 10.1 per 1,000 person-years, respectively) compared with the general population. Excess long-term mortality risk only exists in patients with severe SVD (Fazekas score of 3, presence of lacunes, or lower microstructural integrity). This could help in assisting clinicians to predict the clinical outcomes of patients with SVD by severity.

Clinical outcome of monolithic zirconia on bonded or mechanically retained prefabricated titanium-base: A 4-year retrospective study

ObjectiveTo assess the clinical performance of monolithic screw-retained implant-supported zirconia crowns (MSI) bonded or mechanically retained on prefabricated Ti-bases using a complete digital workflow. MethodsA retrospective analysis was conducted on patients who underwent single dental implant procedures between January 2017 and May 2018. Inclusion criteria were: patients over 18 years of age; implants placed in posterior sites; MSI on prefabricated Ti-base realized by using a complete digital workflow; a minimum follow-up period of 2 years. Cemented crowns and fixed dental prosthesis were excluded. Mechanical complications included: fracture of Ti-base; loss of retention; loosening of Ti-base screws. Technical complications included: fracture and debonding of monolithic zirconia. Biological complication was set strictly at a probing pocket depth of 5 mm and bleeding on probing or pus secretion. ResultsA total of 144 dental implants placed in 127 patients were included, 73 with a fully tapered implant system (BLX) and 71 with a conical connection system (Nobel Parallel CC).Of the 73 BLX implants, 4 experienced loosening of the Ti-base screw, while 3 Nobel Parallel CC implants experienced the same problem. In addition, 4 fractures of the Ti-base and 6 fractures of the inner surface of the monolithic zirconia were observed in the Nobel Parallel CC implants. Cumulative survival was 100 % for bonded crowns and 85 % for mechanically retained crowns. Radiographic evaluation revealed a mean CBL of 0.12 mm for the BLX and 0.13 mm for the Nobel Parallel CC implants with no statistically significant differences between the Ti-base types. There was no evidence of bleeding on probing or pus secretion. All probing pocket depths were <3 mm. ConclusionThe use of a prefabricated Ti-base remains a clinically acceptable choice, however, MSIs bonded to prefabricated Ti-bases had fewer mechanical and technical complications than the MSI mechanically retained to a prefabricated Ti-base.

Tick-borne Encephalitis Clinical Characteristics in Adult Patients: A 10-year Retrospective Study in Stockholm, Sweden.

The incidence of Tick-borne encephalitis (TBE) has increased during the last decades in Europe. Our aim was to assess the clinical characteristics and outcome of TBE patients in Region Stockholm, as a high-risk area in Sweden. The notification database at the regional Department of Communicable Disease Control and Prevention was used to identify TBE cases during 2006-2015. Clinical data was retrieved from the included patients' medical records. The associations of specific variables to predefined outcomes of disease severity were evaluated with multivariate logistic regression models. Of 1004 identified TBE cases, 703 adult patients were included. Sixty-one percent were men, and the median age was 50 years (range 18-94). The majority were non-vaccinated. Comorbidity was present in 34%, and 4% had immunomodulatory therapy. Seventy-five percent were hospitalised, and 11% had severe disease. More than 70% of the 79 patients followed up for more than 6 months had persisting symptoms. The case fatality rate was 1.4%, with 15% in the group with immunomodulatory treatment. In the multivariate analysis, severe disease was associated with underlying comorbidities, age ≥50 years, and previous complete TBE vaccination. This is the largest cohort of TBE patients in Scandinavia. Our findings of a more severe course of disease in patients of older age, with immunomodulatory therapy, with comorbidities, and vaccination breakthrough infections must be interpreted in the context of hospitalised patients. Optimised prevention is needed for patients with immunomodulatory therapy, given the considerable case fatality rate. Follow-up visits and rehabilitation should be better standardised.

A 20-year study reveal decrease in per- and polyfluoroalkyl substances (PFAS) in a pelagic seabird from the Western Mediterranean Sea

Despite the first ban on perfluorooctane sulfonic acid (PFOS) in 2009, it remains unclear whether Europe, a key regulator, has effectively reduced per- and polyfluoroalkyl substances (PFAS) in the environment over the past 20 years. This study investigates the levels and temporal trends of 19 PFAS compounds in the livers of 62 Scopoli's shearwaters (Calonectris diomedea) collected from the Mediterranean basin during 2003–2022. Over the past two decades, PFAS concentrations showed an overall significant decrease of 77%. PFOS was the most frequently and predominantly detected chemical in livers, closely followed by perfluorotridecanoic acid (PFTrDA) and perfluoroundecanoic acid (PFUnDA). However, the contribution of PFTrDA (32.4%) surpassed that of PFOS (30.3%) in 2009–2014, which can be attributed to its increased use as a substitute following the regulation on PFOS in 2009. Perfluoroalkyl carboxylic acids (PFCAs), along with PFOS, showed a general decline over the study periods, with the largest decrease occurring after 2015, corresponding to the regulations on PFCAs. An odd-numbered, long-chain PFCAs accumulation trend was observed in samples. Principal component analysis showed a shift from PFOS to PFCAs in Scopoli's shearwater PFAS patterns over 20 years. Our results offer valuable insights into the environmental behavior of PFAS, the complex interactions between regulations and compounds and their transfer to the marine ecosystems. Despite widespread declines, their persistent detection underscores the need for enhanced international cooperation efforts to comprehensively mitigate PFAS emissions, including those from developing regions and unregulated sources.