7-year Follow-up Research Articles

Age Variation in Patients with Troponin Level Elevation Without Obstructive Culprit Lesion or Suspected Myocardial Infarction with Non-Obstructive Coronary Arteries—Long-Term Data Covering over Decade

Background/Objectives: Troponin level elevation without an obstructive culprit lesion is caused by heterogenous entities. The effect of aging on this condition has been poorly investigated. Methods: After screening 24,775 patients between 2010 and 2021, this study included a total of 373 patients with elevated troponin levels without an obstructive culprit lesion or suspected myocardial infarction with non-obstructive coronary arteries (MINOCAs) categorized into four age groups containing 78 patients (<51 years), 72 patients (51–60 years), 81 patients (61–70 years), and 142 patients (>70 years). This study analyzed the baseline characteristics, the in-hospital complications, in-hospital mortality, and the long-term outcomes. Results: The older patients exhibited a higher rate of major adverse cardiovascular in-hospital events than those of the other age groups (15.4% in the <51-year-old group vs. 36.1% in the 51–60-year-old group vs. 33.3% in the 61–70-year-old group vs. 47.2% in the >70-year-old group; p < 0.001). However, the rate of non-sustained ventricular tachycardia (nsVT) was higher in the 51–60-year-old patients than those of the other age groups (5.6% in the 51–60-year-old group vs. 1.3% in the 61–70-year-old group vs. 0.7% in the >70-year-old group; p = 0.027). At the 11-year follow-up, cardiovascular mortality was higher among the older patients compared to that of the younger patients (3.9% in the 61–70-year-old group vs. 4.2% in the >70-year-old group, p = 0.042), while non-cardiovascular mortality was comparable between the age groups. Conclusions: The older patients with troponin level elevation without an obstructive culprit lesion experienced a higher incidence of major adverse cardiovascular events during hospitalization compared to that of the younger groups. Additionally, higher cardiovascular mortality rates were revealed in the older patients at a long-term follow-up.

Association of age at menopause and suicide risk in postmenopausal women: a nationwide cohort study

IntroductionEarly age at menopause has been linked to various adverse health outcomes, but its association with suicide risk remains underexplored. This study aims to assess the relationship between age at menopause and suicide risk among postmenopausal women.MethodsThis retrospective cohort study analyzed data from the Korean National Health Insurance System (NHIS), covering 1,315,795 postmenopausal women aged 30 years and above, from 2009 to 2021. Menopausal age was classified as primary ovarian insufficiency (under 40 years), early menopause (40-44 years), average menopause (45-49 and 50-54 years), and late menopause (55 years and older). Suicide incidence was identified using ICD-10 codes for primary cause of death. Multivariable Cox proportional hazards models were utilized to estimate hazard ratios (HRs) and 95% confidence intervals (CIs).ResultsAcross the 12-year follow-up, there were 2,986 suicides. Women with primary ovarian insufficiency exhibited the highest suicide risk (HR, 1.43; 95% CI, 1.14–1.78, p < 0.001), followed by those with early menopause (HR, 1.31; 95% CI, 1.15–1.50, p < 0.001), and those with menopause between 45 and 49 (HR, 1.13; 95% CI, 1.04–1.23, p < 0.001) compared to the reference group undergoing menopause at age of 50-54.DiscussionEarly onset of menopause, particularly primary ovarian insufficiency, is associated with a significantly elevated risk of suicide. These findings underscore the need for targeted interventions and support for women experiencing early menopause. This study highlights the importance of monitoring mental health in postmenopausal women and suggests further research to explore the underlying mechanisms linking early menopause to increased suicide risk.

Psychological stress and influence factors in elderly patients with mild coronary heart disease: a longitudinal follow-up study in Shanghai, China

IntroductionEffective health management is crucial for elderly patients with coronary heart disease (CHD). This study applied a Psycho-Cardiology model to CHD management, aiming to assess psychological stress among patients with mild CHD and identify potential influencing factors to provide substantiating evidence.MethodsThis longitudinal study was based on a 9-year follow-up program of a community population in Shanghai, China. A total of 44,552 elderly people were included, with the average age being 74.9 (±10.35) years, and the proportion of female participants being 56.5%. To evaluate and compare the effect of the disease, individuals were categorized into four groups based on their medical records from the past 6 months, these being (I) a CHD with other chronic diseases group, (II) a CHD only group, (III) non-CHD patients with one (or more) chronic disease group, and (IV) non-patient group. Demographic characteristics, sleep quality and health status of each participants were collected using the Unified Needs Assessment Form for Elderly Care Questionnaire. A multivariate logistic regression was used for statistic analysis.ResultsDemographic characteristics differed significantly between the three chronic disease groups (Groups I, II and III) and the non-patient group. Participants in the CHD group reported poorer sleep quality, worse health status, and a more rapid health decline when compared to those with other chronic diseases. Factors such as age, gender, education level, disease duration, and family support were identified as potential influences on the self-reported subjective sleep quality in patients with mild CHD. While age, education level, living status and family support were potential factors influencing the self-assessed health status in participants without CHD (Groups III and IV).ConclusionPatients with mild CHD may experience lower subjective sleep quality, health status scores, and a faster health-sleep decline, indicating elevated psychological stress. Higher education levels offer a protective effect against this stress, highlighting the importance of psycho-emotional interventions and educational strategies. Additionally, it is important to prioritize early intervention for newly diagnosed cases to aid in illness acceptance. These findings provide crucial insights for managing patients with mild CHD and inform the efficient allocation of healthcare resources.

Association of herpes simplex virus infection and vitiligo: a nationwide retrospective cohort study.

Several studies have proposed viral infection with herpes simplex virus (HSV) as a probable cause of vitiligo. We aimed to examine the association between HSV infection and vitiligo. We used the National Health Insurance Research Database of Taiwan to perform a comparative analysis of the study population with or without a diagnosis of HSV infection. The study period was from January 1st, 2008, to December 31st, 2019. The primary outcome was the date of first vitiligo diagnosis, death, withdrawal from the National Health Insurance Program, or end of the study. We performed 1:1 propensity score matching based on age, sex, and comorbidities, resulting in 1,009,445 matched pairs of patients with and without HSV infections. The adjusted hazard ratio for developing vitiligo in the HSV cohort was 1.71 (95% confidence interval, 1.59 - 1.83; P < 0.001). An age-dependent pattern was also observed among HSV-infected patients with vitiligo (P for interaction < 0.001). Both sexes exhibited a significantly higher risk of developing vitiligo in the presence of HSV infection. The HSV cohort significantly increased cumulative vitiligo risk compared to the non-HSV cohort in a 12-year follow-up (log-rank P < 0.001). The result of sensitivity analysis was compatible with that of primary analysis. Patients with HSV infection had a considerably increased vitiligo risk within the 1-year follow-up than the non-HSV cohort (adjusted hazard ratio, 4.83; 95% confidence interval, 4.04 - 5.77, P < 0.001). This nationwide population-based study demonstrated an association between HSV infection and an increased risk of vitiligo. Further investigation of HSV DNA in the affected regions of vitiligo lesions may help to establish causality.

Insights From a 20-Year Follow-Up of the First Heart Transplant Recipient to Complete an Ironman Triathlon.

Insights From a 20-Year Follow-Up of the First Heart Transplant Recipient to Complete an Ironman Triathlon.

Thresholds for conjugated hyperbilirubinaemia and hepatobiliary scintigraphy in biliary atresia: A 12-year national follow-up.

To investigate liver biochemistry in infants screened for biliary atresia (BA) at the time of hepatobiliary scintigraphy (HS) and to evaluate the effect of change in threshold for HS. Infants born from 2010 to 2021, who underwent HS <6 months postpartum for BA, were included and data sourced from electronic medical records. The change in threshold in 2018 from ≥20 (and/or if conjugated bilirubin exceeds 20% of total bilirubin) to ≥17 μM (regardless of total bilirubin) was evaluated. In the cohort of 635 infants, 48 had BA, 247 had AATD, and the remaining 343 were categorised as 'other'. After the threshold adjustment, HS timing was unaffected (p = 0.27), but the annual HS rate rose from 39 to 87, yet evaluations following the new guideline only accounted for 12%. All liver parameters were elevated in the BA group compared with the additional groups (p < 0.001). Amongst the 104 patients with non-excretory HS, gamma-glutamyl transferase (p < 0.001) and alanine aminotransferase (p = 0.002) remained elevated for BA. The lowest conjugated bilirubin measured in BA children was 36 μM. After threshold change, HS use increased without earlier BA diagnostics, but most were not due to the new guideline. Alanine aminotransferase and gamma-glutamyl transferase should be considered in BA diagnostics.

Post-Marketing Safety of Ustekinumab Based on 14-Year Follow-Up in Danish National Patient Data.

Psoriasis (PsO), a chronic inflammatory skin disorder affecting a substantial proportion of populations globally, often necessitates systemic treatment including biologics. This 14-year cohort study, based on Danish national register data, aimed to investigate the enduring safety profile of ustekinumab compared to other systemic psoriasis treatments. Using comprehensive Danish national register data, this study scrutinized patients diagnosed with psoriasis or psoriatic arthritis (PsA) who received ustekinumab. The treatment group comparators were non-biological systemic treatment (non-biologic), tumor necrosis factor α inhibitor medicine groups (TNF-α), interleukin (IL)-17 inhibitors (IL-17), and IL-23 inhibitors (IL-23). The study periods for comparisons were 2009-2022 for non-biologic and TNF-α, 2015-2022 for IL-17, and 2018-2022 for IL-23. Outcomes were malignancies, cardiovascular events, serious infections, and serious hypersensitivity reactions. Cox proportional hazards regression models were employed to analyze two estimands: a standard intention-to-treat (ITT) estimand and a continuous-index-treatment (CIT) estimand, which considered switch and re-initiation of treatments within individuals. Users of ustekinumab were found to be younger on average, with an average age of 45.1 years compared to 51.6, 47.2, 49.0, and 48.4 years in the non-biologic, TNF-α, IL-17, and IL-23 groups, respectively. Also, 57.3% of the ustekinumab users were male, compared to 46.7%, 48.9%, 50.9%, and 58.3% for the non-biologic, TNF-α, IL-17, and IL-23 groups, respectively. Although the hazard ratio estimates varied across comparators, ustekinumab was found to be safe: regardless of PsA status, no discernible safety signals in terms of malignancy, MACE, severe infections, or severe hypersensitivity reactions were observed for ustekinumab when compared to the treatment comparators. The present study corroborated the enduring safety of ustekinumab in the context of PsO treatment.

Formal degree programs in physiology promote careers of clinical scientists and benefit basic science departments.

Physiologists may play critical roles in the development of clinician-scientists who aspire to an academic career. The complexity of contemporary biomedical science and economic matters regarding postgraduate education pose real conundrums. We report a more than 22-year follow-up of surgical trainees pursuing bench laboratory science experience through a collaboration between a physiology postgraduate program and a surgical researcher program within a single public medical school. The sources and resources include selection, funding, physiology classroom work, and laboratory studies with personal involvement by faculty that have seldom been recorded, especially with longer term career outcomes. These selected PhD candidates have subsequently pursued several lines of activity, many with distinguished careers and major influences upon future generations of academic surgeons.

Too early to be different? A multi-institutional study with 30-year follow-up for prognostic factors of completely resected early stage thymoma

Background/Purpose: This multi-institutional study was aimed to analyze prognostic factors of completely resected early stage thymoma. MethodsPatients with surgically treated early stage thymoma between 1988-2019 were enrolled. Statistical associations were evaluated using the χ2 test, Fisher’s exact test, and Student’s t-test. Disease-free survival (DFS) and overall survival (OS) curves were established by the Kaplan-Meier method, and compared using the log-rank test. ResultsA total of 229 patients with Masaoka stage I and 131 with Masaoka stage II thymoma were included. The DFS of patients with Masaoka stage I thymoma was associated with neutrophil-to-lymphocyte ratio (NLR, hazard ratio [HR] = 3.18, 95% confidence interval [CI]: 1.34-7.54), and extrathymic malignancies (HR = 4.51, 95% CI: 2.02-10.11), and the OS was associated with NLR (HR = 5.03, 95% CI: 1.61-15.66) and extrathymic malignancies (HR = 7.68, 95% CI: 3.12-18.97). In patients with Masaoka stage II thymoma, DFS was associated with age (HR = 2.50, 95% CI: 1.18-5.27), extent of surgery (HR = 0.41, 95% CI: 0.19-0.87), and NLR (HR = 3.23, 95% CI: 1.11-9.44), and OS was associated with age (HR = 5.77, 95% CI: 1.81-18.34), surgical approach (HR = 8.40, 95% CI: 1.91-37.00), and extrathymic malignancies (HR = 2.96, 95% CI: 1.08-8.12). ConclusionIn Masaoka stage I thymoma, preoperative NLR and extrathymic malignancies are independently associated with DFS and OS. In Masaoka stage II thymoma, age, extent of surgery, and NLR are independently associated with DFS, and age, surgical approach, and extrathymic malignancies are associated with OS.

Clinical management of an orofacial trauma including multiple avulsions, lateral luxation, and alveolar fracture: A case report with a seven-year follow-up

The occurrence of different types of trauma concomitantly can complicate the establishment of the most appropriate treatment. This report describes the clinical management of orofacial trauma including multiple avulsions, lateral luxation, alveolar fracture, and their sequelae after seven years of follow-up. A 19-year-old woman presented to emergency care four hours after an accidental fall that resulted in the avulsion of teeth #8, #9, and #25; a complicated crown fracture and lateral luxation of tooth #7; an uncomplicated crown fracture of tooth #10; and a fracture of the maxillary alveolar bone. Only teeth #8 and #9 were located by the patient. The immediate treatment included surgical reduction and extrusion of the lateral luxation, delayed replantation of the avulsed central incisors, non-rigid splint stabilization, and suturing of gingival lacerations. Subsequent visits involved removal of the splint, root canal treatment of the maxillary incisors, implant placement to replace the avulsed mandibular incisor, and esthetic rehabilitation with composite resin. At the 5-year follow-up, Cone Beam Computed Tomography revealed advanced surface root resorption in the replanted incisors. At the 7-year follow-up, an aggravation of inflammatory resorption in the replanted incisors was observed. This report demonstrates that adequate knowledge of trauma management by clinicians is essential for the effective management of more complex cases. It also highlights the importance of long-term follow-up in cases of avulsion and replantation due to potential long-term sequelae.

Auditory agnosia progressing to cortical deafness. Long-term follow up of a one-year-old child to age 37

Background There are two types of central auditory disorders due to pathology of the bilateral auditory cortices in adult patients: auditory agnosia with residual hearing; cortical deafness with total hearing loss. However, long-term changes of hearing acuity over physical development time are unknown. Objective The aim of this case report was to illustrate the pathophysiology of auditory changes in a 1 year-3 months old child who was diagnosed with auditory agnosia as a sequel of herpes encephalitis and later developed cortical deafness during a 36-year follow-up. Materials and Methods Brain MRI, hearing tests, ABR, DPOAE and developmental tests of speech/language were periodically performed. Results Brain imaging revealed extensive damage in the bilateral auditory cortices. His auditory speech perception was lost and his language development was seriously delayed. His hearing threshold progressively decreased over time from normal at first to profound hearing loss as a teenager. However, at 29 years of age his ABR was normal. He was able to communicate and converse by sign language or writing. Conclusions and Significance Later developing cortical deafness with profound hearing loss could be caused by retrograde degeneration of the auditory radiation overtime to the bilateral medial geniculate bodies.

Impact of asthma severity on surgical outcomes in patients with chronic rhinosinusitis comorbid with asthma

BackgroundPatients with chronic rhinosinusitis with nasal polyps comorbid with asthma often experience poor outcomes following endoscopic sinus surgery. ObjectiveThis study was designed to evaluate the impact of asthma severity on the long-term outcomes after surgery in these patients. MethodsEighty-three patients with chronic rhinosinusitis with nasal polyps comorbid with asthma who underwent endoscopic sinus surgery were prospectively enrolled in this study. Patients were classified into mild, moderate, and severe asthma groups based on their preoperative asthma severity. Clinical symptom scores, nasal endoscopy scores, and asthma control test results were recorded preoperatively, and at 1 year and 12 years postoperatively. ResultsSeventy-one patients completed the 12-year follow-up. All patients showed significant improvement in nasal symptom scores and nasal endoscopy scores. However, 48 of 71 (67.6%) patients experienced nasal polyp recurrence, and 22 (31.0%) of them underwent revision surgery. Patients in the severe asthma group had the highest rate of nasal polyp recurrence (P=0.02) and revision surgery (P=0.01), and the least improvement in smell disturbance (P=0.04) and general symptom (P=0.02) compared with the other asthma groups. ConclusionPreoperative asthma severity significantly influenced the outcome of endoscopic sinus surgery in patients with chronic rhinosinusitis with nasal polyps comorbid with asthma, in whom endoscopic sinus surgery had a long-term beneficial effect.

Associations of hearing and visual loss with cognitive decline and dementia risk: a 25-year follow-up of the Maastricht Aging Study.

Hearing loss (HL) and visual loss (VL) are recently identified as promising dementia risk factors, but long-term studies with adequate control of other modifiable dementia risk factors are lacking. This 25-year follow-up study investigated the association between objectively measured HL and VL with cognitive decline and incident dementia. 1823 participants (age 24-82years) of the Maastricht Aging Study were assessed at baseline, 6, 12 and 25years. Baseline HL was defined as pure-tone hearing loss ≥20 dB at frequencies of 1, 2 and 4 kHz and VL as binocular, corrected visual acuity <0.5. Associations with cognitive decline (verbal memory, information processing speed, executive function) and incident dementia were tested using linear mixed models and Cox proportional hazard models, respectively. Analyses were adjusted for demographics and 11 modifiable dementia risk factors (LIfestyle for BRAin health index). Participants with HL (n = 520, 28.7%) showed faster decline in all cognitive domains than participants without HL. No consistent association was found for VL (n = 58, 3.2%), but below-average visual acuity (<1) showed significant associations with information processing speed and executive function. No significant associations with dementia risk were found. Findings were independent of demographics and modifiable dementia risk factors. HL predicts faster cognitive decline but not dementia risk in adults aged 24-82years. VL shows no consistent associations, though below-average visual acuity is linked to faster cognitive decline. This study supports HL as an independent risk factor for cognitive decline. Future studies should further evaluate the roles of HL and VL in dementia risk reduction.

Real-Life Individual Comparison of Sodium-Glucose Cotransporter-2 Inhibitors in Patients with Heart Failure and Diabetes Mellitus.

Sodium-glucose cotransporter-2 inhibitors (SGLT2is) are breakthrough agents for the treatment of type 2 diabetes mellitus (T2DM) and heart failure (HF). However, among patients with HF and T2DM, some uncertainty remains about individual comparisons, including dosing. We aimed to make a real-life individual comparison of SGLT2is among patients with HF and T2DM. This was a subgroup analysis of the Turkish Ministry of Health's National Electronic Database for adult patients with HF (TRends-HF). All-cause mortality (ACM) data up to 7 years were evaluated. Patients with HF and T2DM who were prescribed an SGLT2i were identified, and individual doses of empagliflozin 25 mg, empagliflozin 10 mg, and dapagliflozin 10 mg were compared. For individual comparisons, propensity score-matching analysis was generated as 1:1:1, and disease-modifying therapies (DMTs) for HF were considered. In the triple-matched cohort, 1-, 5-, and 7-year survival rates were 95%, 81%, and 76% versus 94%, 78%, and 72% versus 94%, 80%, and 75% for empagliflozin 25 mg, empagliflozin 10 mg, and dapagliflozin 10 mg, respectively. Among patients who were on triple DMT for HF, 1-, 5-, and 7-year survival rates were 95%, 78%, and 70% for empagliflozin 25 mg, 95%, 74%, and 66% for empagliflozin 10 mg, and 94%, 77%, and 69% for dapagliflozin, respectively. Annual emergency department visits were slightly lower with empagliflozin 10 mg and dapagliflozin 10 mg than with empagliflozin 25 mg. A greater proportion of patients on dapagliflozin 10 mg did not experience hospitalization during the 7-year follow-up compared with both doses of empagliflozin, albeit with a small effect size. Among patients with HF and T2DM, SGLT2is are instrumental, and empagliflozin 10 mg remains significantly inferior to dapagliflozin 10 mg and empagliflozin 25 mg in terms of 5- and 7-year ACM.

Overall satisfaction following laparoscopic fundoplication for patients with atypical extraesophageal symptoms: A comparative cohort study.

Some patients with gastroesophageal reflux (GERD) experience extraesophageal symptoms, which are considered due to laryngopharyngeal reflux (LPR). Most studies evaluating fundoplication for LPR report outcomes from individuals who also have typical esophageal GERD symptoms. Information is limited for patients with LPR but no GERD symptoms. To determine whether LPR patients benefit from fundoplication outcomes were determined for individuals with LPR±GERD and also those without LPR. Patients undergoing fundoplication from 1997 to 2015 were identified and divided into three symptom groups: LPR only, LPR and GERD, and GERD only. Heartburn, dysphagia, and satisfaction were assessed using 0-10 analog scores and compared at short (1-2years) and later (5years) follow-up. 2204 patients underwent fundoplication. 24 patients had LPR only, 130 patients had LPR and GERD, and matched to 1319 patients with GERD only. At 1-2 years follow-up, the LPR only group had lower satisfaction scores than those with GERD symptoms (± concurrent LPR) (7.00±3.49 vs. 8.41±2.42, p=0.019, and mean±s.d.). At 1-2years, 68.1% of the LPR only group had a good outcome (satisfaction score: 7-10) versus 84.6% with LPR and GERD and 84.1% with GERD only. At 1-2years follow-up, patients with LPR only were less satisfied following fundoplication compared with patients with typical GERD (±LPR). However, some patients with LPR only did benefit and might be considered for surgery if appropriately counseled. Outcomes were similar for patients with LPR and typical GERD and those with only typical symptoms.

Kidney and blood pressure outcomes 11years after pediatric critical illness and longitudinal impact of AKI: a prospective cohort study.

Acute kidney injury (AKI) is common in critically ill children and associated with adverse short-term outcomes; however, long-term outcomes are not well described. This longitudinal prospective cohort study examined the prevalence of chronic kidney disease (CKD) and hypertension (HTN) 11 vs. 6years after pediatric intensive care unit (PICU) admission and association with AKI. We examined children (age < 19years) without pre-existing kidney disease 11 ± 1.5years after PICU admission at a single center. AKI was defined using serum creatinine criteria. The primary outcome was a composite of CKD or HTN. CKD was defined as estimated glomerular filtration rate (eGFR) < 90mL/min/1.73 m2 or albuminuria. Multivariable analyses compared outcomes at 11- vs. 6-year follow-up and association with AKI during PICU admission. Of 96 children evaluated 11years after PICU admission, 16% had evidence of CKD or HTN (vs. 28% at 6years, p < 0.05). Multivariable analysis did not show improvement in outcomes from 6- to 11-year follow-up. eGFR decreased from 6- to 11-year follow-up (adjusted coefficient - 11.7, 95% CI - 17.6 to - 5.9) and systolic and diastolic blood pressures improved. AKI was associated with composite outcome at 6-year (adjusted odds ratio (aOR) 12.7, 95% CI 3.2-51.2, p < 0.001), but not 11-year follow-up (p = 0.31). AKI was associated with CKD (aOR 10.4, 95% CI 3.1-34.7) at 11years. This study provides novel data showing that adverse kidney and blood pressure outcomes remain highly prevalent 10years after critical illness in childhood. The association with AKI wanes over time.

Trabecular Metal Augments for the Management of Paprosky Type III Defects Without Pelvic Discontinuity: Average 11-Year Follow-Up in Cases with Previously Reported 4-Year Clinical Results

This retrospective case series aimed to assess the clinical and radiographic outcomes of revision total hip arthroplasty with trabecular metal (TM) augments associated with cementless TM acetabular components for the management of Paprosky type IIIA and IIIB defects without pelvic discontinuity. There were 83 hips (82 patients) enrolled. There were 53 patients who completed the clinical and radiological follow-up (64% of the total) who had a mean follow-up of 11 years (range, seven to 16.6). There were seven patients who died during the follow-up period without undergoing further revision, and 23 were lost to follow-up. A Paprosky type IIIA defect was found in 42 hips, whereas a Paprosky type IIIB defect was present in 11 hips. We previously reported short-term outcomes for 55 hips that underwent acetabular reconstruction using TM cups associated with TM augments with a mean follow-up of 53.7 months. Here, we followed the clinical and radiological outcomes of the aforementioned patients and 28 more hips. We retrospectively collected the clinical and radiological data of all the patients operated on in our tertiary referral center between 2005 and 2016. The average Harris Hip Score (HHS) increased from 36.4 (range, 24 to 53) preoperatively to 87.4 (range, 63 to 100) at the last follow-up. The cumulative survival of the acetabular construct at seven years of follow-up was 90.6% (95% CI [confidence interval]: 78.8 to 95.9) considering revision for any reason, and at 10 years of follow-up was 86.3% (95% CI: 73.4 to 93.2). The cumulative survival of the acetabular construct at seven years of follow-up was 94.2% (95% CI: 83.2 to 98.1) considering revision for aseptic loosening, and at 10 years of follow-up was 92.1% (95% CI: 80.4 to 97). The use of TM cups and augments could be considered an effective management of Paprosky type III defects without pelvic discontinuity. The present technique provides an anatomical reconstruction of the defect with the restoration of the hip center of rotation (COR) associated with good clinical and radiographic outcomes in the mid-term.

Joint association of METS-IR and uric acid with stoke, mediated by C-reactive protein.

To explore the dose-response relationship between the Metabolic Score of Insulin Resistance (METS-IR), uric acid (UA) and the risk of stroke incidence, the mediating role of C-reactive protein (CRP) in the above relationship, as well as the joint effect of METS-IR and UA on the risk of stroke incidence. Participants from the CHARLS study were included in this cohort study. Logistic regression models were used to estimate the odds ratios (ORs) and corresponding 95% confidence intervals (CIs) for the associations of METS-IR and UA with the risk of incident stroke. The dose-response relationships of METS-IR and UA with stroke risk were assessed by restricted cubic spline regression. The mediation models were employed to estimate the potential mediating effects of CRP on the associations of METS-IR and UA with stroke risk. Logistic regression analysis was carried out to analyse the association of stroke and MRTS-IR combined with UA. During a 9-year follow-up from 2011 to 2018, 570 incident cases of stroke were documented among 7,343 total participants. Per interquartile range increases in METS-IR and UA were associated with the increased risk of incident stroke, with the OR (95% CI) of 1.61 (1.44, 1.80) and 1.18 (1.05, 1.32) respectively. A dose-response function showed that METS-IR had a nonlinear relationship (P for nonlinear=0.047) and UA had a linear relationship (P for nonlinear=0.247) with the stroke risk. CRP had significant mediated effects on the associations of METS-IR and UA with stroke risk, and the proportion of mediation was 9.01% and 26.34% respectively (all P < 0.05). The results of joint effect showed that participants with high levels of METS-IR and UA had the highest increased risk of stroke compared to the participants with low levels of METS-IR and UA. METS-IR and UA levels were positively associated with an increased risk of stroke onset, and CRP mediated these relationships. Improving insulin sensitivity and regulating CRP and uric acid levels may be important for preventing the risk of stroke occurrence.

Can simple measures from clinical practice serve as a proxy for sarcopenic obesity and identify mortality risk?

BackgroundSarcopenic obesity is a condition where loss of muscle mass occurs alongside fat gain, and it is considered a risk factor for mortality. However, the use of various definitions for this condition has led to conflicting results.AimTo investigate whether the coexistence of low muscle mass and abdominal obesity, defined using two simple measures employed in clinical practice, is a risk factor for mortality in individuals aged 50 or older.MethodsA longitudinal study with a 14-year follow-up was conducted involving 5,440 participants of the English Longitudinal Study of Ageing. Abdominal obesity and low muscle mass were respectively defined based on high waist circumference and low skeletal muscle mass index (SMMI) determined by an equation. The sample was divided into four groups: non-low muscle mass/non-abdominal obesity (NLMM/NAO), non-low muscle mass/abdominal obesity (NLMM/AO), low muscle mass/non-abdominal obesity (LMM/NAO), and low muscle mass/abdominal obesity (LMM/AO). Cox regression models were used to estimate the mortality risk as a function of muscle mass and abdominal obesity status.ResultsLMM/AO increased the risk of death by 83% (HR:1.83; 95%CI: 1.35–2.66) compared to those in the NLMM/NAO group. AO alone was not associated with a greater risk of mortality (HR:1.09; 95%CI: 0.93–1.27), whereas LMM alone increased the risk by 40% (HR:1.40; 95%CI:1.18–1.66).ConclusionsIdentifying LMM/AO in individuals aged 50 or older can be crucial for predicting the risk of mortality. Simple and easily applicable measures can serve as a proxy for sarcopenic obesity and aid in implementing the necessary interventions.

A Cost-Effectiveness Analysis of Gonadotropins Used for Ovarian Stimulation during Assisted Reproductive Technology Based on Data from the French Nationwide Claims Database (SNDS)

Objective: Various gonadotropins are used for ovarian stimulation (OS). This study investigated the cost-effectiveness of different gonadotropins based on real-world data from the French National Health Database (SNDS) over a 7-year follow-up of assisted reproductive technology (ART) treatments. Design: Cost-effectiveness analysis of different gonadotropins based on real-world data from the SNDS was conducted. Participants: Women from SNDS undergoing OS leading to oocyte pick-up registered between January 31, 2013, and December 31, 2018 (N = 245,534 stimulations), and receiving either recombinant human follicle stimulating hormone (r-hFSH alfa originator; 110,439), its biosimilars (12,287), or urinaries (mainly highly purified human menopausal gonadotropin [HP-hMG; 65,654] and marginally highly purified urinary-human follicle stimulating hormone [7,821]) were included (follow-up: December 31, 2019). Settings and Methods: Clinical inputs for this model, including live birth (LB) and cumulative LB (CLB) were calculated from data as published in [Best Pract Res Clin Obstet Gynaecol. 2023;88:102308]. A decision-tree model was developed comprising pregnancy and live birth rate (LBR) states for a complete ART cycle, including one fresh and ≤4 frozen/thawed embryo transfers and related costs. Cost inputs included those of drugs, ART procedure, pregnancy and delivery, and adverse events. Cost per LB and CLB and incremental cost-effectiveness ratio (ICER) were assessed. Robustness of results was determined by comprehensive sensitivity analyses. Results: Overall, r-hFSH alfa originator was found to be associated with a lower cost per LB and per CLB (cost per LB: EUR 26,010; CLB: EUR 22,278) versus its biosimilars (cost per LB: EUR 28,037; CLB: EUR 23,807) and versus urinaries (cost per LB: EUR 26,636; CLB: EUR 23,335). Calculated ICERs with r-hFSH alfa for LB were EUR 5,538 and EUR 14,090, whereas for CLB were EUR 1,945 and EUR 13,742 versus biosimilars and urinaries, respectively. Cost-effectiveness acceptability curve showed that in a majority of iterations, r-hFSH alfa originator had a probability of being cost-effective at a hypothetical threshold of EUR 20,000/LB. Sensitivity analyses showed that the most important variable impacting the outcome in fresh transfers was the probability of birth for biosimilars and the probability of pregnancy for urinaries, while for cumulative transfers, it was the probability of pregnancy for biosimilars and the probability of birth for urinaries. Limitations: As the clinical data were obtained from a non-interventional study and not a randomized controlled trial, the results may still be susceptible to residual confounding or other biases. Conclusions: r-hFSH alfa originator is cost-effective compared to its biosimilars and to urinaries (mainly HP-hMG) and is associated with a lower cost per LB compared to these gonadotropins, where the main driver is the higher LB efficacy rate achieved with it.