7-year Follow-up Research Articles

Long-term durability and temporal pattern of revisional surgery of laparoscopic large hiatal hernia repair.

Laparoscopic repair is the preferred surgical treatment for symptomatic Large Hiatal Hernia (LHH). However, data on long-term outcomes are limited. This study aims to evaluate the 20-year follow-up results of laparoscopic LHH repair in a high-volume experienced tertiary center. Retrospective analysis of patients who underwent elective laparoscopic LHH repair between 1992 and 2008. Preoperative and perioperative data were collected. The primary endpoint was the long-term reoperation rate. Survival analyses were calculated according to the Kaplan-Meier method and compared with the log-rank test. A Cox proportional hazard model was used to investigate predictive factors of the need for revisional surgery. A total of 176 patients were included. All the procedures were performed laparoscopically, and in 5 cases (3.0%) with a robot-assisted approach. Mesh-augmented cruroplasty was performed in 26 patients (15.8%). A fundoplication was added in all patients: Nissen in 158 (89.8%), Toupet in 5 (2.8%), and Collis-Nissen in 13 (7.4%). Postoperative mean follow-up was 224.6 ± 83.3months. Clinically significant hiatal hernia recurrence occurred in 27 (16.2%), and 18 patients (10.2%) underwent surgical revision. The median time-to-redo was 12months (IQR 6-42months). Overall durability without revisional surgery at 20-year follow-up was 90%. The rate of revisional surgery after LHH repair is low and is generally required within 12months from primary surgery. Our results highlight the long-lasting effects of LHH repair at 20-year follow-up.

Assessing the predictive value of elevated triglycerides, triglyceride-glucose index (TyG), and TG/HDL ratios for cardiovascular disease and mortality during 20 years of follow-up: Tehran lipid and glucose study.

Cardiovascular disease (CVD) remains a leading cause of morbidity and mortality globally, influenced by a complex interplay of risk factors including lipid disorders and insulin resistance (IR). The triglyceride-glucose (TyG) index and the triglyceride to high-density lipoprotein cholesterol (TG/HDL) ratio have emerged as potential indicators for assessing cardiovascular risk. This study aimed to evaluate the predictive value of hypertriglyceridemia, the TyG index, and the TG/HDL ratio for mortality and CVD occurrence within an Iranian population. Conducted within the Tehran Lipid and Glucose Study over 20 years, this research analyzed 7,117 participants to assess the association between these lipid biomarkers and CVD risk and mortality. Participants were stratified by their TyG and TG/HDL indices, with Cox proportional hazards models determining risk ratios across three adjusted models considering various demographic and clinical variables. The study found significant associations between elevated triglycerides, TyG, and TG/HDL levels with increased risks of mortality and CVD during the 20-year follow-up. Specifically, the hazard ratios for CVD events were notably significant in the second triglyceride group (150-250 mg/dL), with a hazard ratio of 1.36 (1.19-1.55) in both Model 1 and Model 2, and in the third group (250-400 mg/dL), with ratios of 1.88 (1.63-2.17) in Model 1, 1.90 (1.65-2.19) in Model 2, and 1.44 (1.24-1.67) in Model 3. Hypertriglyceridemia, the TyG index, and the TG/HDL ratio are easily calculable and clinically relevant markers for cardiovascular risk assessment. Their integration into routine health evaluations could facilitate early detection and management of at-risk individuals, potentially reducing the incidence and impact of CVD within the community.

Natural History and Long Term Follow-Up of Incidental Thyroid Nodules on Computed Tomography Imaging.

incidental thyroid nodules (ITNs) are found in up to 25% of CT scans. Increased use of cross-sectional imaging has contributed to the increased incidence of thyroid cancer worldwide. ITNs pose a management dilemma since nodule malignancy rate is 5-15% but most cancers are indolent and prognosis in differentiated thyroid cancer is excellent. Study aims are to determine prevalence of ITNs ≥1 cm on CT scans, evaluate reporting practices, assess for emergence of clinically evident thyroid cancer during 13-year follow-up and assess interim nodule growth and clinical outcomes in nodules that were further investigated. direct image review of 1499 consecutive CT scans that included the thyroid, performed during January 2009 in a large NHS health board was performed. Clinical data up to January 2022 was analysed in 150 patients with at least one ITN > =1cm. ITN prevalence was 11% with mean patient age 70 years and mean nodule diameter 17.5 mm. 30% of ITNs were mentioned in the CT report. During the follow-up period 11% proceeded to thyroid ultrasound, 5% fine needle aspiration and 2% diagnostic hemithyroidectomy with no thyroid malignancy found. 120 patients (80%) were deceased by the study endpoint, none from thyroid malignancy. No patients presented with clinically evident thyroid malignancy during follow-up. None of150 ITN cases developed clinically evident thyroid malignancy in a 13-year follow-up period with 80% of patients deceased by the study endpoint from non-thyroid causes. This would suggest that ITNs detected on CT do not require further investigation unless malignant appearances or significant clinical concern for thyroid malignancy.

Sex-specific DNA methylation marks associated with sex-biased risk of recurrence in unprovoked venous thromboembolism.

Whether to stop oral anticoagulants after a first unprovoked venous thromboembolism (VTE) is challenging, partially due to an intriguingly higher risk of VTE recurrence (rVTE) in men after therapy discontinuation. DNA methylation (DNAm) differences between men and women might underly this sex-biased rVTE risk difference. To investigate sex-specific associations between DNAm at cytosine-phosphate-guanine (CpG) sites and rVTE. In 417 unprovoked VTE patients, including 101 experiencing recurrences over 5-year follow-up (REVERSE I), we analyzed blood DNAm using the Illumina EPIC array and performed a sex-stratified epigenome-wide association study. We further examined 181 major provoked VTE patients, including 36 recurrences over 14-year follow-up (MARTHA), to investigate whether DNAm are risk factors for rVTE after anticoagulation therapy. Hypomethylated CpGs at genes TBC1D22B-cg01060850 and ZHX2-cg07808424 in men and DIP2B-ch.12.1038646R and DENND3-cg03401656 in women were associated with rVTE at genome-wide level (p<7e-8). Though not statistically significant, DENND3-cg03401656 had the same direction of effect in MARTHA women. Sensitivity analysis confirmed the robustness of the estimates including potential confounders, adaptations of the Cox model, non-Europeans, and proximal methylation quantitative trait loci (meQTLs) in the association. The associated CpGs were situated at genes for membrane trafficking, corroborating the participation of Rab regulatory proteins in rVTE, and transcription factors. We identified DNAm marks as potential risk factors for sex-biased recurrence in unprovoked VTE. Further replication and experimental validation could refine our understanding on the regulation of the identified DNAm sites and help optimize personalized decision-making for long-term anticoagulation after first VTE.

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.

Curve progression in non-surgically treated patients with idiopathic scoliosis: a cohort study with 40-year follow-up.

Treatment of idiopathic scoliosis in childhood aims to prevent curve progression. It is generally accepted that curves > 50° have the highest risk of progression, but less well described is what happens with mild to moderate curves. The aim of this study was to assess long-term curve progression and health-related quality of life (HRQoL) and compare thoracic and thoracolumbar/lumbar (TL/L) curves. We identified 177 patients diagnosed with a pediatric spinal deformity and treated at our institution from 1972 through 1983. 91 of 129 eligible patients with idiopathic scoliosis completed follow-up (71%). Patient files from treatment/observation in childhood were reviewed including detailed descriptions of radiographs. At follow-up we assessed long standing full-spine radiographs and HRQoL with the Scoliosis Research Society 22 revised questionnaire. Mean follow-up was 41 years (standard deviation [SD] 2.5 years). 21 patients underwent surgery in adolescence or early adulthood leaving 70 patients for analysis of curve progression, of whom 61 had complete radiographs. For patients with a main curve < 25° at the end of treatment in adolescence (n = 19) mean curve progression was 7° (SD 9); for 25-40° curves (n = 26) 16° (SD 13); for 40-50° curves (n =10) 22° (SD 8); and for curves > 50° (n = 6) 17° (SD 6). There was a linear association between main curve size at follow-up and SRS-22r subtotal score (P = 0.003). We found substantial curve progression for patients with main curves > 25° at end of treatment, but with a considerable variation between patients. Curve progression was not associated with curve size at the end of treatment and did not differ significantly between thoracic and TL/L curves. Larger main curve size at follow-up was associated with lower HRQoL.

Risk of Dementia After Uterus or Prostate Resection: 17-Year Follow-Up of a Population-Based Retrospective Cohort Study.

The purpose of this retrospective study was to determine the effect of surgical operation, age at surgery, sex hormones, and anesthesia modality on the risk of dementia in both sexes. Data of females aged between 30 and 70 years old who were diagnosed with dysmenorrhea and underwent hysterectomy/myomectomy or without surgery, and males with benign prostate hyperplasia (BPH) with or without transurethral resection of the prostate (TURP) were identified from the National Health Insurance Research Database 2000-2016. The effect of age at surgery, surgery type, and anesthesia modality on dementia risk was assessed using Cox regression analyses. Among the 855,893 subjects, 10,242 developed dementia. Surgery at older age increased dementia risk in both sexes. Among females, hysterectomy/myomectomy was not significantly associated with dementia risk, although myomectomy was associated with a lower risk for dementia than hysterectomy. In males, TURP significantly increased the risk of dementia. Men with BPH and women with dysmenorrhea who were older at surgery have a higher risk of dementia. Regardless of the anesthetic method, surgery increased the risk of dementia in men. Among the data of women, although the surgery factor was not significantly associated with dementia risk, women with myomectomy had a lower risk of dementia than the ones with hysterectomy. These findings together contributed to risk stratification for each sex in such surgical settings.

Sustained alcohol service refusal rates to underage patrons in nightlife setting: 25-year follow-up of a Swedish alcohol prevention program

In 1996, a multicomponent alcohol prevention intervention was launched and later institutionalized in Stockholm. This study examines the long-term effects of the program on compliance with the legal minimum age limit for alcohol service at licensed premises. The intervention comprised community mobilization and collaboration, training, and enforcement aimed at preventing alcohol service to underage (<18years) or obviously intoxicated patrons. Six cross-sectional studies were conducted between 1996 and 2022 in Stockholm using pseudo-underage mystery shoppers attempting to enter licensed premises and order alcoholic beverages. The primary outcome was refusal of entry to the premises or refusal of alcohol service. Throughout the study period, regular collaboration meetings were held, the number of annual inspections and trained staff increased, and the number of sanctions varied. The refusal rate of alcohol service to pseudo-underage mystery shoppers rose from 54.8% in 1996 (baseline) to 59.1% in 1998, 67.6% in 2001, 88.3% in 2007, 91.3% in 2013, and 79.6% in 2022. Compared to the reference year 1996, all rates from 2001 to 2022 showed significant increases in the odds of refusal. The multicomponent alcohol prevention program has been successfully sustained through collaboration and community mobilization, training, and enforcement. This success is evidenced by consistently high refusal rates for alcohol sales to underage customers over an extended period.

Change in Metabolic Markers and the Risk of Skin Cancer: Results from the Lifelines Cohort Study in the Netherlands.

Skin-cancers are the most common cancers in Caucasians, and their incidence is rising. Although metabolic and anthropometric markers play a role in cancer development, the relationship of metabolic and anthropometric changes with skin-cancer remains unclear. This study aimed to examine possible associations between these changes and the risk of skin-cancer. Participants without prior skin-cancer history from the Northern-Netherlands representative of the general population were included. Histopathology data were obtained from the Dutch Nationwide Pathology-Database. Adjusted-Cox-regression analyzed associations between metabolic changes and time to pathology-confirmed skin-cancer incidence over a 7-year follow-up, assessing overall skin-cancer risk and subtypes, including melanoma and non-melanoma skin-cancer. Out of 97,106 participants, 4,195 (4.3%) developed skin-cancer. Body-mass-index (BMI) decrease and increase were both associated with lower skin-cancer risk: adjusted-hazard-ratios(aHR) of 0.88(0.80-0.98) and 0.78(0.72-0.86), respectively. Triglyceride and waist-to-hip ratio (WHR)decreases were also associated with lower risk: aHR: 0.89(0.80-0.98) and 0.89(0.83-0.98), respectively. Increase in HbA1c was associated with higher risk in individuals under 45 years at baseline: aHR: 1.21(1.01-1.45). Subtype-analysis showed an increase in BMI was associated with lower melanoma risk: aHR: 0.72(0.58-0.91). Changes in BMI and decrease in triglycerides and WHR are related to lower skin-cancer risk, whereas increase in HbA1c may elevate risk in individuals younger than 45 at baseline. These findings highlight the importance of non-sunlight-related risk factors for skin-cancer prevention and the need for further research into underlying mechanisms. This study contributes to the broader understanding of how metabolic health impacts skin-cancer development, offering potential avenues for targeted prevention strategies.

Exploring survival rates in HIV-infected Ethiopian children receiving HAART: a retrospective cohort study

BackgroundStudies have shown a high rate of mortality among adults despite the introduction of highly active antiretroviral therapy (HAART). However, long-term outcomes of HAART among children remain poorly documented in...

Assessment of Long-Term Engagement in Aerobic Versus Resistance Exercise on 20-Year Cardiovascular Disease Incidence (2002-2024): The ATTICA Epidemiological Cohort Study.

Objective: The aim of this study was to assess whether aerobic exercise, as opposed to resistance training or a combination of both, is associated with long-term cardiovascular outcomes. Methods: The ATTICA study is a population-based cohort study with a 20-year follow-up (2002-2022); it was conducted in the Attica region, Greece, and included 3042 adult participants (45 ± 11 years, 1518 females). Physical activity engagement in aerobic, resistance, or combined exercise, and 20-year tracking, together with information regarding atherosclerotic cardiovascular disease (ASCVD) incidence were available for 1988 participants (45 ± 12 years old, 987 males, 1001 females). Physical activity levels were evaluated using the validated International Physical Activity Questionnaire, in all follow-up examinations (2001-2002, 2006, 2012, and 2022). Cox proportional hazard models were applied; the results are presented as hazard ratio (HR) and 95% confidence intervals (CIs). Results: Participants engaged in the combined (aerobic and resistance) physical activity group had 0.41-times [95%CI (0.20, 0.82)] lower ASCVD risk compared to inactive participants; participants in the healthy engaging aerobic physical activity (HEPA) group had 0.54-times [95%CI (0.36, 0.80)] lower ASCVD risk; no significant associations were observed regarding the minimally active aerobic group [HR, 0.81, 95%CI (0.57, 1.17)], or the resistance training only group [HR, 1.17, 95%CI (0.25, 1.52)]. Conclusions: These findings carry a strong public health message, underscoring the importance of incorporating aerobic or combined aerobic-resistance training into physical activity guidelines to enhance cardiovascular health and reduce the long-term risk of CVD.

U-Shaped Association Between Dietary Copper Intake and New-Onset Chronic Kidney Disease: A 30-Year Follow-Up Study From Young Adulthood to Midlife.

The relationship of dietary copper intake with new-onset chronic kidney disease (CKD) remained unclear. We aimed to examine the association of dietary copper intake with new-onset CKD in a 30-year follow-up study from young adulthood to midlife. A total of 4038 U.S. adults aged 18-30 years and without reduced estimated glomerular filtration rate (eGFR) from the Coronary Artery Risk Development in Young Adults (CARDIA) study was included. During a 30-year follow-up, 642 (15.9%) participants developed new-onset CKD. Overall, there was a U-shaped relationship between dietary copper intake and new-onset CKD (p for nonlinearity = 0.034). When copper intake was assessed as quartiles, compared with those in the second quartile (2.03-<2.46mg/day), the adjusted hazard ratios (HRs) (95% confidence interval [CI]) for new-onset CKD were 1.29 (1.05, 1.66), 1.29 (1.02, 1.64), and 1.49 (1.16, 1.91) for participants in the first (<2.03mg/day), third (2.46-<3.11mg/day), and fourth (≥3.11mg/day) quartiles, respectively. Similar U-shaped associations were observed for new-onset eGFR decline and albuminuria. There was a U-shaped relationship of dietary total copper intake with new-onset CKD, with the lowest risk at a dietary copper intake of 2.03-<2.46mg/day. Emphasizing the importance of maintaining optimal copper intake levels for the primary prevention of CKD.

Association of falls with risk of dementia and all-cause mortality: a cohort study of Japanese older adults with a 9-year follow-up.

Many risk factors affect dementia and all-cause mortality. However, whether falls are a risk factor for dementia and all-cause mortality is unclear. The study examines the association of falls with the risk of dementia and all-cause mortality, and whether dementia mediates the association of falls with all-cause mortality. Data were taken from the Japanese Gerontological Evaluation Study (JAGES) with a 9-year follow-up. Falls information was collected through a questionnaire and categorized into no falls, single and multiple falls. Dementia and all-cause mortality data were obtained from the long-term care insurance (LTCI) system. The Cox proportional hazard models were used to calculate the hazard ratios (HRs) and 95% confidence intervals (95% CIs), and causal mediation analysis (CMA) was used to assess the mediating effects of dementia. A total of 52,076 participants were included in the study. Compared to participants with no falls, participants with single and multiple falls had an increased risk of dementia (single fall, HRs = 1.18, 95% CIs 1.12-1.24; multiple falls, HRs = 1.66, 95% CIs 1.56-1.77) and all-cause mortality (single fall, HRs = 1.09, 95% CIs 1.04-1.15; multiple falls, HRs = 1.34, 95% CIs 1.26-1.43), and the risk increased with the number of falls (P for trend < 0.01). In addition, dementia significantly mediated the association between falls and risk of all-cause mortality (NIE: HRs = 1.02, 95% CIs 1.00-1.04, PM = 15.0%). Falls are associated with the risk of dementia and all-cause mortality. Dementia has important mediating effects in the association between falls and the risk of all-cause mortality.

Occupation and 11-year lung function decline in the HUNT Study.

The association between occupational titles and lung function has mostly been examined through cross-sectional studies. Preventive measures are expected to mitigate adverse effects; hence, updated estimates are necessary. To study change in lung function measured by spirometry across occupations. This population-based prospective cohort study comprised 5618 working adult participants of the Trøndelag Health Study (HUNT3, 2005-07), Norway. Among these, 3800 individuals (43% men, mean age 42 years, range 20-55) also attended HUNT4 (2017-19). We analysed longitudinal decline in forced expiratory volume in 1 second (FEV1) z-score during the 11-year follow-up by occupation (white-collar workers as reference category), in mixed models, adjusting for age, sex and smoking. We assessed the prevalence of self-reported respiratory symptoms and disease in the working population in HUNT4 (n = 32 124) and HUNT3 (n = 32 070). Compared with white-collar workers, agricultural workers and 'drivers and mobile plant operators', had larger declines in FEV1 z-score during follow-up. In sex-stratified analyses, men defined as agricultural workers and 'drivers and mobile plant operators' had larger declines than white-collar workers. Among women, who were underrepresented in many blue-collar jobs, workers classified as 'machine operators and assemblers' experienced greater declines. In the working population in HUNT4, the prevalence of respiratory symptoms in connection with work was 8%, and lower among white-collar workers (6%) than blue-collar workers (14%). Although certain workers in Norway remain at risk for occupational lung function decline, there were modest differences between occupations. The findings encourage continuous efforts to implement preventive measures in high-risk jobs.

Full-thickness arthroscopic rotator cuff repair demonstrates low repair failure rates and high return to sport rates in patients aged 30 years and under at 9-year follow-up: A single-center case series.

The purpose of this study is to assess the long-term clinical complications, outcomes, and return to sport (RTS) rates in patients aged 30 or younger with a primary full-thickness arthroscopic rotator cuff repair (ARCR). All patients who underwent a primary full-thickness ARCR at age 30 years or younger from 2003 to 2021 with a minimum of a 2-year follow-up were included. Complications, repeat surgeries, and return to sport rates were collected. 32 patients underwent primary full-thickness rotator cuff repair with a mean follow-up of 9.3[2.7-17.9] years. 5(15.6%) patients had postoperative shoulder stiffness, and persistent postoperative shoulder pain was reported in 4(12.5%) patients. There were 3(9.4%) reported repair failures, with complete rotator cuff re-tears reported in 2(6.3%) shoulders and partial rotator cuff re-tear in 1(3.1%) shoulder. There were 4(12.5%) reoperations at an average of 8.7[0.65-22.7] months from primary rotator cuff repair and 2(6.3%) revision rotator cuff repairs. There was a 78.6% RTS rate at an average of 6.5[4-12] months postoperatively, with 8(72.7%) athletes returning to the sport at the same level they initially participated in pre-surgery. Patients aged 30 and under who underwent full-thickness ARCR experienced promising clinical outcomes at an average 9-year follow-up. Retrospective Case Series; Level of Evidence, 4.

A prediction study on the occurrence risk of heart disease in older hypertensive patients based on machine learning

ObjectiveConstructing a predictive model for the occurrence of heart disease in elderly hypertensive individuals, aiming to provide early risk identification.MethodsA total of 934 participants aged 60 and above from the China Health and Retirement Longitudinal Study with a 7-year follow-up (2011–2018) were included. Machine learning methods (logistic regression, XGBoost, DNN) were employed to build a model predicting heart disease risk in hypertensive patients. Model performance was comprehensively assessed using discrimination, calibration, and clinical decision curves.ResultsAfter a 7-year follow-up of 934 older hypertensive patients, 243 individuals (26.03%) developed heart disease. Older hypertensive patients with baseline comorbid dyslipidemia, chronic pulmonary diseases, arthritis or rheumatic diseases faced a higher risk of future heart disease. Feature selection significantly improved predictive performance compared to the original variable set. The ROC-AUC for logistic regression, XGBoost, and DNN were 0.60 (95% CI: 0.53–0.68), 0.64 (95% CI: 0.57–0.71), and 0.67 (95% CI: 0.60–0.73), respectively, with logistic regression achieving optimal calibration. XGBoost demonstrated the most noticeable clinical benefit as the threshold increased.ConclusionMachine learning effectively identifies the risk of heart disease in older hypertensive patients based on data from the CHARLS cohort. The results suggest that older hypertensive patients with comorbid dyslipidemia, chronic pulmonary diseases, and arthritis or rheumatic diseases have a higher risk of developing heart disease. This information could facilitate early risk identification for future heart disease in older hypertensive patients.

What is the clinical importance of radiographic changes around the humeral component in anatomic shoulder arthroplasty? A minimum 4-year follow-up study.

While stress shielding and adaptive bone changes around the humeral component are often observed after shoulder arthroplasty, the potential causative factors and clinical significance of these findings at mid-term follow-up have not been well elucidated. The purpose of this study was to investigate the frequency, patterns and clinical significance of radiographic findings around the humeral component of total shoulder arthroplasty (TSA) and hemiarthroplasty (HA) at minimum 4-year follow-up. The 6-week and minimum 4-year radiographs of patients who underwent HA and TSA were evaluated for filling ratios, changes in the humeral bone surrounding the component, and component shift or subsidence. All procedures were performed using a traditional-length, smooth stem fixed by impaction autografting with the goal of secure fixation with a relatively low filling ratio. Radiographs after TSA were evaluated for high-grade radiolucencies around the glenoid component. The clinical outcomes of interest were revision for humeral fixation failure and Simple Shoulder Test (SST) score. 170 patients met the study criteria (91 TSA and 79 HA). The mean radiographic and clinical follow-up was 7.0 years [interquartile range (IQR), 5.3 to 8.6 years]. No patients were revised for loose humeral components during the study period. For both HA and TSA, the most common zones of cortical thinning or resorption involved the medial calcar, greater tuberosity and lateral humerus diaphysis. The mean metaphyseal filling ratio (MFR) was higher in patients with bone changes in ≥3 zones (p < 0.001) and resorption of the calcar (p = 0.051). The frequency and degree of bone changes around the humeral component were higher in TSA patients with high-grade radiolucencies around the glenoid component. These findings in TSA patients with high-grade radiolucencies around the glenoid component had a stronger correlation with inferior SST scores than in patients who did not have a high-grade radiolucencies around the glenoid component. At minimum 4-year and mean 7-year follow-up, greater bone changes around the humeral component were associated with higher metaphyseal filling ratios. The association of glenoid component radiolucency with the degree and clinical impact of these bone changes should be considered when interpreting mid-term radiographs after TSA and may represent the effects of other processes - such as osteolytic reaction to particulate debris - in addition to stress shielding. Level IV; Case Series; Treatment Study.

Adjuvant Dose-Dense Chemotherapy in Hormone Receptor-Positive Breast Cancer.

In light of evolving evidence that some patients with node-positive estrogen receptor-positive (ER+) disease may receive less benefit from chemotherapy, this study reports 12-year outcomes of the C9741 trial overall, and by the sensitivity to endocrine therapy (SET2,3) test index, a biomarker measuring endocrine transcriptional activity, to identify patients most likely to benefit from dose-dense chemotherapy. In all, 1,973 patients were randomly assigned to dose-dense versus conventional chemotherapy. Hazard ratios (HRs) for prognosis and for predictive interaction with chemotherapy schedule were estimated from Cox models of long-term disease-free survival (DFS) and overall survival (OS). SET2,3 was tested on the 682 banked RNA samples from ER+ cancers. Dose-dense chemotherapy improved DFS in the overall study population by 23% (HR, 0.77 [95% CI, 0.66 to 0.90]) and OS by 20% (HR, 0.80 [95% CI, 0.67 to 0.95]); the benefits of dose-dense therapy were seen for ER+ and ER-negative subsets, without significant interaction between treatment arm and ER status. Low SET2,3 status was highly prognostic, but also predicted improved outcomes from dose-dense chemotherapy (interaction P = .0998 for DFS; 0.027 for OS), independent of menopausal status. Specifically, low endocrine transcriptional activity predicted benefit from dose-dense chemotherapy, whereas tumor burden and proliferation-driven signatures for molecular subtype classification did not. At 12-year follow-up, C9741 confirmed the sustained long-term benefit of adjuvant dose-dense chemotherapy for node-positive breast cancer. SET2,3 identified patients with ER+ breast cancer who benefited from dose-dense chemotherapy, and specifically, this benefit was predicted by low endocrine activity in the cancer, rather than tumor burden, molecular subtype, or menopausal status.

Long-Term Real-World Survival of Immunotherapy Compared to Chemotherapy for Metastatic Nonsmall Cell Lung Cancer: A Propensity Score-Matched Analysis.

The long-term real-world effect of immunotherapy (IO) is uncertain in metastatic nonsmall cell lung cancer (mNSCLC). This retrospective observational study aimed to describe treatment patterns following the introduction of IO, estimate real-world treatment effects of IO compared to standard of care, and evaluate the impact of introduction of IO on a real-world population, based on a large dataset of over 10 000 patients with several years of follow-up. Data from routine care of lung cancer patients were extracted from Flatiron Health including those who received either IO or platinum-based doublet chemotherapy (PBDC) in the first line (1L), or either IO or chemotherapy (CT) in the second line (2L). Real-world overall survival (rwOS) and real-world time to next therapy (rwTTNT) were estimated using Cox regression. Flexible parametric models, relaxing proportional hazard assumptions, were used to evaluate long-term IO effects. After 1:1 nearest neighbor matching among 16 754 1L and 6548 2L patients, the hazard ratio (HR) was 0.942 (95% CI, 0.902-0.984) in 1L and 0.853 (95% CI, 0.795-0.915) in 2L. Adjusting for crossover effects, HR was 0.887 in 1L and 0.775 in 2L. Over the 7-year follow-up, the mean rwOS benefit was 3.2 months for 1L and 2.7 months for 2L. IO significantly delayed rwTTNT in both 1L and 2L. The IO effects increased and persisted over time, with uncertainty in the time-varying HR estimate. IO improves survival in patients with mNSCLC, though the effect size is smaller than in trials and long-term survival estimates are uncertain.

Effect of statins and antihyperglycemics on chronic kidney disease in patients with type 2 diabetes mellitus: a retrospective cohort study with a 12-year follow-up.

Chronic Kidney Disease (CKD) represents a significant worldwide health challenge, with far-reaching implications for both patients and healthcare systems. This study aimed to identify the incidence of CKD at stages 3-5, analyzed the impact of statin and other antihyperglycemic interventions, on the CKD progression in individuals with T2DM. This was a single-center retrospective cohort study based on data derived from electronic medical records (EMR) of UAE populations with diabetes mellitus, registered at outpatient clinics at Tawam Hospital in Al Ain, UAE, between January 2011 and December 2021. T2DM patients aged ≥ 18 years who had serum HbA1c level ≥ 6.5% and using one of the statin therapies were inclusion criteria. Patients with T1DM, who had undergone permanent renal replacement therapy, with under 1 year of follow-up and missing or incomplete data were excluded from the study. The collected data encompassed socio-demographics, detailed medical history, anthropometric measurements, laboratory analyses, clinical parameters, disease characteristics, and medications. Our study included a cohort of 1,003 individuals. We observed 388 subjects developed CKD stages 3-5 across an average monitoring duration of 11.7 years. This resulted in a cumulative incidence of 38.7%, translating to an incidence rate of 38 cases per 1000 person-years. There was a statistically significant difference in the cumulative incidence of CKD stages 3 ± 5 according to statin therapy (P = 0.047). High intensity statin users are more likely to develop a CKD stage 3-5 compared to low/moderate intensity users and to no statin users respectively (44.3% vs 37.9%), (44.3% vs 30.9%). Conversely, the use of Biguanides was associated with a decreased probability of CKD progression (37.9% vs. 52.8%; P = 0.001), whereas Insulin users demonstrated a heightened risk (54.2% vs. 34.1%; P < 0.001). The findings emphasise the pivotal role of personalised treatment strategies, particularly concerning statin therapy and other medications, in populations at high risk.