Adjustment For Relevant Factors Research Articles

Levels of Sex Hormones and Abdominal Muscle Composition in Men from The Multi-Ethnic Study of Atherosclerosis

Information on the associations of testosterone levels with abdominal muscle volume and density in men is limited, while the role of estradiol and SHBG on these muscle characteristics are unclear. Therefore, this study aimed to investigate the association between fasting serum sex hormones and CT-derived abdominal muscle area and radiodensity in adult men. Conducted as a cross sectional observational study using data from the Multi-Ethnic Study of Atherosclerosis, our analyses focused on a community-based sample of 907 men aged 45–84 years, with 878 men having complete data. CT scans of the abdomen were interrogated for muscle characteristics, and multivariable linear regressions were used to test the associations. After adjustment for relevant factors, higher levels of both total testosterone and estradiol were associated with higher abdominal muscle area (1.74, 0.1–3.4, and 1.84, 0.4–3.3, respectively). In the final analyses, levels of total testosterone showed a positive association, while an inverse relationship was observed for SHBG with abdominal muscle radiodensity (0.3, 0.0–0.6, and − 0.33, − 0.6 to − 0.1, respectively). Our results indicate a complex association between sex hormones and abdominal muscle characteristics in men. Specifically, total testosterone and estradiol were associated with abdominal muscle area, while only total testosterone was associated with muscle radiodensity and SHBG was inversely associated with muscle radiodensity.Clinical Trial: NCT00005487

Association of smoking cessation patterns and untreated smoking with glaucoma, cataract, and macular degeneration: a population-based retrospective study

This study aims to assess the association between nicotine replacement therapy (NRT), varenicline, and untreated smoking with the risk of developing eye disorders. We employed a new-user design to investigate the association between NRT use and the incidence of eye disorders by the Taiwan National Health Insurance program. This study included 8416 smokers who received NRT and 8416 smokers who did not receive NRT (control group) matched using propensity scores between 2007 and 2018. After adjustment for relevant factors, a multivariable Cox regression analysis revealed that compared with untreated smokers, NRT use was associated with a significantly reduced risk of macular degeneration (hazard ratio [HR]: 0.34; 95% confidence interval [CI]: 0.13–0.87, P = 0.024). When stratified by dose, short-term NRT use (8–28 defined daily doses) was associated with significantly lower risk of glaucoma (HR: 0.35; 95% CI: 0.16–0.80, P = 0.012) and a trend toward reduced risk of cataract (HR: 0.60; 95% CI: 0.36–1.01, P = 0.053) compared to no treatment. However, these associations were not observed with long-term NRT use. The results of this real-world observational study indicate that NRT use, particularly short-term use, was associated with a lower risk of certain eye disorders compared to no treatment for smoking cessation. Long-term NRT use did not demonstrate the same benefits. Thus, short-term NRT may be a beneficial treatment strategy for reducing the risk of eye disorders in smokers attempting to quit. However, further evidence is required to verify these findings and determine the optimal duration of NRT use.

Relationship Between Fasting Blood Glucose and Readmission Within 1 Year in Elderly Patients with Heart Failure.

Elevated blood glucose has been linked to unfavorable outcomes among individuals with heart failure (HF). Nevertheless, evidence is scarce regarding the association between fasting blood glucose (FBG) levels and the likelihood of readmission within one year for elderly patients. To address this gap, a retrospective cohort study was conducted, integrating electronic health records of restricted health data from PhysioNet. The study focused on HF patients aged 60 years and older, utilizing baseline data, comorbidities, and laboratory test results as covariates. A total of 374 patients were included in the study. The relationship between 1-year readmission rates and various glucose levels was assessed using Kaplan-Meier plots. The analysis employed three multivariate Cox regression models to examine patients with varying glucose levels. Following adjustments for relevant factors, an association was observed between FBG levels and the rate of readmission in elderly patients with HF (HR=1.0264 [95% CI 0.9994-1.0541]). The diabetes group faced a higher risk of readmission compared to the normal group. However, this difference in outcome events was not statistically significant, with hazard ratios and their corresponding 95% confidence intervals of 1.2134 (0.9811~1.5007), 1.2393 (0.9993~1.5371), and 1.1905 (0.9570~1.4809), respectively. The robustness of the model was further demonstrated through risk models with subgroup analysis, revealing that FBG levels consistently exerted a stable effect on outcome events, unaffected by covariates such as age, gender, body mass index, glomerular filtration rate, and brain natriuretic peptide. These findings suggest a notable association between elevated FBG at the time of initial hospitalization and the likelihood of readmission within one year among elderly patients with HF.

Accuracy of Tests for Diagnosis of Animal Tuberculosis: Moving Away from the Golden Calf (and towards Bayesian Models)

The last decades have seen major efforts to develop new and improved tools to maximize our ability to detect tuberculosis-infected animals and advance towards the objective of disease control and ultimately eradication. Nevertheless, there is still uncertainty regarding test performance due to the wide range of specificity and especially sensitivity estimates published in the scientific literature. Here, we performed a systematic review of the literature on studies that evaluated the performance of tuberculosis diagnostic tests used in animals through Bayesian Latent Class Models (BLCMs), which do not require the application of a (fallible) reference procedure to classify animals as infected with tuberculosis or not. BLCM-based sensitivity and specificity estimates deviated from those obtained using a reference procedure for certain antemortem tests: an overall lower sensitivity of skin tests and serology and a higher sensitivity of interferon-gamma (IFN-γ) assays was reported. In the case of postmortem diagnostic tests, sensitivity estimates from BLCMs were similar to estimates from studies based on other methodologies. For specificity, the range of BLCM-based estimates was narrower than those based on a reference test, reaching values close to 100% (but lower in the case of IFN-γ assays). In conclusion, Bayesian methods have been increasingly applied for the evaluation of tuberculosis diagnostic tests in animals, yielding results that differ (sometimes substantially) from previously reported test performance in the literature, particularly for in vivo tests and sensitivity estimates. Newly developed models that allow adjustment for relevant factors (e.g., age, breed, region, and herd size) can contribute to the generation of more unbiased estimates of test performance. Nevertheless, although BLCMs for tuberculosis do not require the use of an imperfect reference procedure and are therefore not influenced by its limited performance, they require careful implementation, and transparent systematic reporting should be the norm.

Associations among Health Status, Occupation, and Occupational Injuries or Diseases: A Multi-Level Analysis.

The present study used a hierarchical generalized linear model to explore the effects of physical and mental health and occupational categories on occupational injuries and diseases. The data were obtained from the Registry for Beneficiaries of the 2002-2013 National Health Insurance Research Database. The benefit categories involved adults with occupational injuries and diseases. Six major occupational categories and 28 subcategories were used. The main analysis methods were binary logistic regression (BLR) and hierarchical generalized linear model (HGLM). After adjustment for relevant factors, the three major occupation subcategories most likely to develop occupational injuries and diseases were Subcategory 12 "employees with fixed employers" of Category 1 "civil servants, employees in public or private schools, laborers, and self-employed workers"; Subcategory 2 "employees in private organizations" of Category 1; and "sangha and religionists" of Category 6 "other citizens." Conditions such as mental disorders and obesity increased the risk of occupational injuries and diseases. A portion of the occupational categories had a higher risk of occupational injuries and diseases. Physical and mental health issues were significantly correlated with occupational injuries and diseases. To the authors' knowledge, this is the first study to use HGLM to analyze differences in occupational categories in Taiwan.

Lithium in drinking water and Alzheimer's dementia: Epidemiological Findings from National Data Base of Japan.

The aim of this study was to investigate the association between lithium levels in drinking water and prevalence of Alzheimer's dementia (AD). Lithium levels in the drinking water of 808 cities and wards (i.e., 785 Japanese cities of 46 prefectures and 23 wards of Tokyo) in Japan were examined in relation to the prevalence of AD during the 5 years from 2010 to 2014, which was calculated on the basis of the national data base of Ministry of Health, Labor, and Welfare of Japan. Multiple regression analyses were used to investigate the association of lithium levels with the prevalence of AD with adjustment for relevant factors (proportions of one-person households as a family factor and people in primary industry employment as a job factor, annual total sunshine hours as a meteorological factor, and total number of beds of psychiatric hospitals as a medical factor) in total, male, and female elderly populations. The adjusted model showed a significant inverse association of lithium levels with female, but not with male, or total prevalence of AD. These findings suggest that higher lithium levels in drinking water may be associated with lower prevalence of AD in female, but not male, populations.

The Relationship of COVID-19 Morbidity and Mortality with the History of Influenza Vaccination.

Background: COVID-19 is currently the leading global health issue. Low- and middle-income countries (LMICs) face challenges in supplying COVID-19 vaccines. To assess an adjunctive preventive measure for COVID-19 burden, we aimed to evaluate the relationship of influenza vaccination in the previous year with outcomes of COVID-19 in affirmed cases after adjustment for relevant factors. Methods: This prospective study was conducted using the provincial registry of confirmed COVID-19 cases in East-Azerbaijan province in North-West of Iran. The main outcomes were COVID-19 mortality and hospitalization. The influenza vaccination history in 2019 was collected by phone calls. Data analysis was done by SPSS software version 16, separately for healthcare workers and the general population. The logistic regression model was applied to compare the covariates in influenza vaccinated versus unvaccinated patients. Results: From 1 March to 10 October 2020, 17,213 positive COVID-19 cases were registered, of which 916 patients were included. A total of 88 patients (9.6%) deceased due to COVID-19. Two hundred subjects (21.8%) reported receiving the influenza vaccine during the past year. Healthcare workers had a significantly higher vaccination rate than the general population (28.9% vs. 7.1%; p<0.001). After adjustment for socioeconomic and health covariates, the vaccinated cases in the general population had 84% lower odds of death (OR: 0.16; 95%CI: 0.05-0.60; p=0.017). In multivariate analysis, the influenza vaccination history in the previous year was not significantly related to the lower COVID-19 hospitalization rate. Conclusion: The flu vaccination rate was not optimal in our community. The flu vaccination can be an independent preventing factor for COVID-19 mortality in the general population. The influenza vaccine can be considered as an effective adjutant preventive countermeasure for the COVID-19 burden.

Is vegetarianism related to anxiety and depression? A cross-sectional survey in a French sample

ObjectiveThe relationship between vegetarianism and mental health is controversial. The aim of the present study is to examine the cross-sectional association between anxiety, depression, and vegetarianism in a French sample while controlling for potential confounders.DesignSelf-reported questionnaire data were obtained from a large cross-sectional sample.Participants and settingWe included an online sample of 6578 participants aged 18–90, 70.8% females.ResultsAnalyses of variance with age, gender, body mass index (BMI), educational level, monthly income, and city size as covariates showed that vegetarians and non-vegetarians did not appear to have significantly different levels of anxiety or depression.ConclusionOur findings do not suggest a link between plant-based diet and anxiety or depression, either before or after adjustment for relevant factors.

Replacing wood with charcoal fuel prevents 1.7 million acute respiratory infections worldwide; evidence from 360,000 children in 30 low-and-middle-income countries

BACKGROUND AND AIM: Household air pollution from solid biomass fuel cooking is responsible for 45% of acute respiratory infections (ARI) in children under five years in low and middle income countries (LMICs). Transition towards less polluting solid biomass fuel sources in LMIC settings, such as moving from wood to charcoal, may reduce HAP-related global respiratory disease burden in the short to medium-term. However, there remains a paucity of evidence concerning the relative health benefits. This study aimed to assess the association between ARIs in children under five years residing in wood and charcoal cooking households in 30 LMICs using the Demographic and Health survey (DHS) data. METHODS: Cross-sectional data was extracted for 30 LMIC countries with 359,647 children residing in wood or charcoal, using outcome measures obtained from maternally reported respiratory symptoms two weeks prior to interview. Composite measures of ARI (cough and shortness of breath) and severe ARI (cough, shortness of breath and fever) were formed. Multilevel logistic regression analyses was deployed, with adjustment for relevant factors at an individual, household, regional and country level. RESULTS:Residence in a wood cooking household was observed to increase the odds ratio of shortness of breath (AOR:1.04[1.00-1.08]) fever (AOR:1.08[1.04-1.13]), ARI (AOR:1.04[1.00-1.08]) and severe ARI (AOR:1.09[1.05-1.13]) compared to residing in charcoal cooking households. Living in a rural areas has an observed association with cough (AOR:1.11[1.04-1.19]), fever (AOR:1.10[1.04-1.18]), ARI (AOR:1.10[1.04-1.18]) and severe ARI (AOR:1.08[1.01-1.15]) and wood fuel usage, whereas only fever (AOR:1.10[1.02-1.18]) was associated with living in urban areas CONCLUSIONS:Evidence from this population-based multilevel study suggest that 1.7 million ARI cases annually could be prevented in children under five years through transitioning from wood to charcoal cooking fuel in resource poor settings. KEYWORDS: Air pollution, Children’s environmental health, Risk assessment, Environmental Epidemiology, Infectious Disease

Physical Activity, Sleep, and Sedentary Behavior among Successful Long-Term Weight Loss Maintainers: Findings from a U.S. National Study.

Despite adults’ desire to reduce body mass (weight) for numerous health benefits, few are able to successfully lose at least 5% of their starting weight. There is evidence on the independent associations of physical activity, sedentary behaviors, and sleep with weight loss; however, this study provided insight on the combined effects of these behaviors on long-term body weight loss success. Hence, the purpose of this cross-sectional study was to evaluate the joint relations of sleep, physical activity, and sedentary behaviors with successful long-term weight loss. Data are from the 2005–2006 wave of the National Health and Examination Survey (NHANES). Physical activity and sedentary behavior were measured with an accelerometer, whereas sleep time was self-reported. Physical activity and sleep were dichotomized into meeting guidelines (active/not active, ideal sleep/short sleep), and sedentary time was categorized into prolonged sedentary time (4th quartile) compared to low sedentary time (1st–3rd quartiles). The dichotomized behaviors were combined to form 12 unique behavioral combinations. Two-step multivariable regression models were used to determine the associations between the behavioral combinations with (1) long-term weight loss success (≥5% body mass reduction for ≥12-months) and (2) the amount of body mass reduction among those who were successful. After adjustment for relevant factors, there were no significant associations between any of the independent body weight loss behaviors (physical activity, sedentary time, and sleep) and successful long-term weight loss. However, after combining the behaviors, those who were active (≥150 min MVPA weekly), regardless of their sedentary time, were significantly (p < 0.05) more likely to have long-term weight loss success compared to the inactive and sedentary referent group. These results should be confirmed in longitudinal analyses, including investigation of characteristics of waking (type, domain, and context) and sleep (quality metrics) behaviors for their association with long-term weight loss success.

Association of diurnal calorie trajectory with all-cause mortality: Findings from the National Health and Nutrition Examination Survey

The effect of diurnal variation in energy intake on mortality has not been reported. We investigated the effect of diurnal calorie trajectory on all-cause mortality using data from the National Health and Nutrition Examination Survey (NHANES). Participants in the NHANES from 1999 to 2010 were analyzed. We calculated daily energy intake and the two-hourly calorie intake according to dietary interview questionnaires, in which timing of meals, as well as energy and nutritional components of each food were recorded. The daily energy intake and the two-hourly calorie intake were divided by body weight to determine tertiles of daily energy intake and diurnal calorie trajectories, respectively. Three diurnal calorie trajectories (reference group, excess dinner, and high-calorie) were identified. The mortality data were linked to the National Death Index through the end of 2011. Cox proportional hazards models were used to compare the overall mortality among different groups. Among the 14,356 participants included in our analyses, 886 (6.2%) of them died after a median follow-up of 4.4 years. Daily energy intake tertiles were not associated with all-cause mortality in the fully adjusted model. In contrast, high-calorie trajectory was associated with a higher risk of mortality (hazard ratio 3.128, 95% CI 1.175 to 8.330, p=0.024) compared with the reference group after adjustment for relevant factors. A diurnal high-calorie trajectory was associated with a higher risk of mortality, compared with the reference group. The effect of a large evening meal on mortality merits further investigation.

Work, life, and the gender effect: Perspectives of ACVIM Diplomates in 2017. Part 1-Specialty demographics and measures of professional achievement.

BackgroundBarriers to achieving work‐life balance, as well as gender‐based differences, exist in the male‐dominated surgical specialty in veterinary medicine. Similar information does not exist for the more feminized American College of Veterinary Internal Medicine (ACVIM).Hypothesis/ObjectivesTo provide data on the professional and personal lives of Diplomates of the ACVIM so as to help define the state of the specialty, including gender‐related differences, and identify areas requiring intervention to improve work‐life balance.SampleA total of 896 surveys (781 completed) of Diplomates of the ACVIM, including cardiology, large animal internal medicine, neurology, oncology, and small animal internal medicine.MethodsAn 82‐item online survey was distributed in February 2017 to ACVIM Diplomates via their respective ACVIM listserv. Participation was voluntary.ResultsThirty percent of the total ACVIM registered membership responded and 26% completed surveys; 25% were men and 75% were women. Specialists in academia worked significantly more hours, with larger numbers of diplomates per specialty section, and made less money compared with those in private practice. Women were less likely to report full‐time employment, practice ownership, or higher academic rank, and reported 20% lower income overall (after adjustment for relevant factors) as compared with men. Men and women differed in their subjective assessment of the effect of gender in the workplace. Eighty‐three percent of respondents were somewhat satisfied or better with their career.Conclusions and Clinical ImportanceSpecialization in the ACVIM is a satisfying and potentially profitable career. However, despite a highly feminized workforce, significant gender‐related imbalances are evident.

Type 2 myocardial infarction among critically ill elderly patients in the Intensive Care Unit: the clinical features and in-hospital prognosis.

Type 2 myocardial infarction (T2MI) refers to myocardial ischemic necrosis as a result of myocardial oxygen supply/demand mismatch, which are common comorbidities of critically ill patients. The purpose of this study was to investigate the incidence rate and risks of T2MI in critically ill elderly patients and further elucidate in-hospital prognostic factors. A total of 223 critically ill elderly patients admitted to our hospital from October 2016 to September 2018 were recruited. The clinical data and the in-hospital mortality rate were compared between the T2MI and non-T2MI groups. Multivariate linear regression analysis was used to identify independent factors related to T2MI. The clinical data and incidence of T2MI were also compared between patients who survived and those who died; multivariate regression analysis was used to identify independent risk factors for in-hospital death and survival analysis was conducted. In this study, the incidence of T2MI was 24.2% (54/223), and the mortality rate of critically ill elderly patients was 39.0% (87/223). Multivariate linear regression analysis showed that severe hypoxemia, arrhythmia, shock, and multiple organ dysfunction syndrome (MODS) were independent risk factors of T2MI. Compared to the survival patients, the use of mechanical ventilation, the incidence of T2MI, APACHE II score, troponin T, high-sensitivity C-reactive protein, and procalcitonin levels were significantly higher in patients who died, while the estimated glomerular filtration rate (eGFR) was significantly decreased (all P < 0.05). In-hospital mortality was significantly increased in patients with T2MI (59.3% vs. 32.5%, P < 0.001). After adjustment for relevant factors, the incidence of T2MI, mechanical ventilation required, and eGFR reduction were independent and significant predictors of in-hospital death. Critically, ill elderly patients have a high incidence of T2MI. In addition to severe hypoxia, shock, and arrhythmia, MODS is also associated with T2MI. At the same time, the risk of in-hospital death is increased in patients with type 2 MI.

Relationship between hyperthymic temperament, self-directedness, and self-transcendence in medical students and staff members.

We aimed to investigate the hypotheses that hyperthymic temperament may be positively associated with self-directedness and self-transcendence with adjustment for relevant factors. Using the database of our previous studies, the data from 111 healthy subjects with scores for both the Temperament and Character Inventory and the Temperament Evaluation of Memphis, Pisa, Paris, and San Diego Autoquestionnaire were secondarily used for the present study. Hyperthymic Temperament scores were significantly and positively associated with Self-Transcendence scores, but not with Self-Directedness scores, following adjustment for relevant factors. Despite the lack of association between self-transcendence and self-directedness, cooperativeness was significantly and positively associated with self-transcendence and self-directedness, but not with hyperthymic temperament. Moreover, despite the lack of association between hyperthymic temperament and self-directedness, harm avoidance was significantly and negatively associated with hyperthymic temperament and self-directedness, but not with self-transcendence. The present findings suggest that hyperthymic temperament may be positively associated with self-transcendence, but not with self-directedness. Moreover, hyperthymic temperament may be, a selfish and reckless trait, self-transcendence may be altruistic and not reckless, and self-directedness may be altruistic but reckless.

Association between early serum cholinesterase activity and 30-day mortality in sepsis-3 patients: A retrospective cohort study.

Low serum cholinesterase (SCHE) activity has been associated with poor prognoses in a variety of conditions, including sepsis. However, such an association has not been well characterized since the Third International Consensus Definitions Task Force modified the definition of sepsis to “life-threatening organ dysfunction due to a dysregulated host response to infection” (known as sepsis-3) in 2016. In the current retrospective cohort study, we examined whether 30-day mortality in sepsis-3 patients is associated with SCHE activity. A total of 166 sepsis-3 patients receiving treatment at an emergency intensive care unit (EICU) were included. The 30-day death rate was 33.1% (55/166). SCHE activity upon EICU admission was lower in nonsurvivors (3.3 vs. 4.5 KU/L in survivors, p = 0.0002). Subjects with low SCHE activity (defined as <4 KU/L) had higher 30-day mortality rates than subjects with normal SCHE activity (45.5%, 40/88 vs. 19.2%, 15/78; p<0.001). A multivariate logistic regression analysis revealed an association between 30-day mortality and lower SCHE activity after adjustments for relevant factors, such as acute multiple organ dysfunction. The odds ratio (OR) for every unit decrease in SCHE activity was 2.11 (95% confidence interval (CI), 1.37–3.27; p = 0.0008). The area under the curve (AUC) of SCHE activity for predicting 30-day mortality was 0.67 (95% CI 0.59–0.74), and the AUC of lactate for predicting 30-day mortality was 0.64 (95% CI 0.57–0.70). Using a combination of SCHE and lactate, the AUC was 0.74 (95% CI 0.69–0.83). These data suggest that lower SCHE activity is an independent risk factor for 30-day mortality in sepsis-3 patients.

Factors influencing access to palliative radiotherapy: a Norwegian population-based study

Background Palliative radiotherapy (PRT) comprises half of all radiotherapy use and is an effective and important treatment modality for improving quality of life in incurable cancer patients. We have described the use of PRT in Norway and aimed to identify and quantify the impact of factors associated with PRT utilization. Material and methods Population-based data from the Cancer Registry of Norway identified 25,281 patients who died of cancer, 1 July 2009–31 December 2011. Additionally, individual-level data on socioeconomic status and community-level data on travel distance were collected. The proportion of patients who received PRT in the last two years of life (PRT2Y) was calculated, and multivariable logistic regression was used to determine factors that influenced the PRT2Y. Analyses of geographic variation in PRT use were also performed for the time period 2012–2016. Results PRT2Y for all cancer sites combined was 29.6% with wide geographic variations (standardized inter-county range; 21.8–36.6%). Female gender, increasing age at death, certain cancer sites, short survival time, and previous receipt of curative radiotherapy were associated with decreased odds of receiving PRT. Patients with low education, those living in certain counties, or with travel distances 100–499 km, were also less likely to receive PRT. Patients with low household income (adjusted odds ratio (OR) = 0.63; 95% confidence interval (CI) = 0.56–0.72) and those diagnosed in hospitals without radiotherapy facility (OR = 0.70; 95% CI = 0.64–0.77) had especially low likelihood of receiving PRT. Significant inter-county variation in use of PRT remained during the time period 2012–2016. Conclusions Despite a publicly funded, universal healthcare system with equity as a stated health policy aim, utilization of PRT in Norway is significantly associated with factors such as household income and availability of radiotherapy facility at the diagnosing hospital. Even after adjustments for relevant factors, unexplained geographic variations in PRT utilization exist.

Cyclothymic temperament and glucose metabolism in the right superior parietal lobule

Cyclothymic temperament possesses a central dimension that includes rapid fluctuations in mood and emotional instability, and it is regarded as a prodromal state of bipolar disorder. The aim of the present study is to explore the neural correlates of cyclothymic temperament. We used the data of 55 healthy participants in our previous study and analyzed the association between cyclothymic temperament scores rated by the Temperament Evaluation of Memphis, Pisa, Paris and San Diego-Autoquestionnaire (TEMPS-A) and the uptake of [18F]-FDG measured by positron emission tomography (PET). A whole brain analysis revealed a cluster of [18F]-FDG uptake significantly and positively associated with cyclothymic temperament scores, located in the right superior parietal lobule (SPL). Even after adjustment for relevant factors, there remained a significant cluster of [18F]-FDG uptake with cyclothymic temperament scores in the right SPL. In ROI analyses, there were similar significant peaks in the right SPL in association with cyclothymic temperament scores. These findings suggest that the right superior parietal lobule may be one of the neural correlates of cyclothymic temperament.

Impact of Treatment with Iron Chelators in Lower-Risk MDS Patients Participating in the European Leukemianet MDS (EUMDS) Registry

▪Background Overall survival (OS) of lower-risk myelodysplastic syndrome (LR-MDS) patients treated with red blood cell transfusions (RBCT) is inferior to that of untransfused patients. RBCTs are associated with iron toxicity. Therefore, many transfused LR-MDS patients receive iron chelation according to (inter)national guidelines. The value of iron chelation in LR-MDS remains unproven. The aim of this study is to assess in a prospective, observational setting the efficacy of iron chelation to counteract the effects of iron overload in LR-MDS.Methods Three iron chelators are available in Europe for treatment of iron overload, but availability varies from country to country. We first assessed the impact of treatment of the 3 iron chelators on survival among the 195 patients treated with iron chelation. Secondly, we developed a model of a contemporary, observational control within the EU-MDS registry of patients who met the inclusion criteria, but who did not receive iron chelation.Results The EUMDS registry has accrued 2084 patients as of July 21, 2016. At this point, 195 patients had received chelation therapy (table). 82 (42%) Patients had died (22 after progressing to AML) and 34 alive patients had progressed to AML. The median time on chelation for all 195 patients was 15 months. Still-living patients had a median time on chelation of 18 months. Of the chelated patients, 149 received deferasirox as the initial chelator, 36 deferoxamine and 10 deferiprone. Treatment duration of the 3 different chelators and the use of the 3 chelators per country is given in table. Twenty patients switched from one chelator to another, but usually the treatment period of the 2nd chelator was short compared to the treatment period of the 1st chelator (data not shown). The Kaplan-Meier estimate showed a significantly better OS for the 149 patients initially treated with deferasirox compared to the 36 patients treated with desferoxamine (log rank p = 0.0021). Multivariate analysis of the 2 groups showed a hazard ratio (HR) of 2.2 (95% CI: 1.3-3.6) and after adjustment a HR of 1.9 (95% CI: 1.1-3.3). We compared the outcome of a non-chelated control group of 573 transfusion dependent patients with 192 chelated patients who achieved one of the following inclusion criteria, recommended to start iron chelation according to (inter)national guidelines: >15 units of RBCT or >1 unit/month during a 6-month period between visits or ferritin >1000 mg/L. Patients were analysed from time of reaching the criteria using receipt of chelation as the time-varying covariate. The unadjusted HRs and 95% CIs were: 1.2 (0.92 - 1.5) and 1.3 (0.95 - 1.7) after adjustment for relevant factors (p = 0.10). The corresponding risk estimates for the analyses restricted to the 149 patients initially treated with deferasirox were 1.5 (1.1 - 2.0) and 1.6 (1.2 - 2.3) respectively (p = 0.006).Interpretation Clinical practice of iron chelation in LR-MDS varied considerably in the 17 European countries participating in the EUMDS Registry. The most frequently used chelator is deferasirox. Use of this chelator varied from 0% to 25% per country. OS was significantly better after treatment with deferasirox when compared to the classical chelator deferoxamine. OS was also significantly better when compared with a large control group of 573 patients, even after adjustment for all relevant prognostic factors. [Display omitted] [Display omitted] DisclosuresFenaux:Celgene, Janssen, Novartis, Astex, Teva: Research Funding; Celgene, Novartis, Teva: Honoraria. Symeonidis:Genesis: Honoraria; Roche: Honoraria; Amgen: Honoraria; Takeda: Consultancy, Honoraria. Almeida:Alexion: Speakers Bureau; BMS: Speakers Bureau; Novartis: Consultancy, Speakers Bureau; Shire: Speakers Bureau; Celgene: Consultancy, Research Funding, Speakers Bureau. Savic:Novo Nordisk: Other: Investigator. de Witte:Incyte: Consultancy; Celgene: Consultancy; Novartis: Honoraria, Research Funding.

Circulating linoleic acid and alpha-linolenic acid and glucose metabolism: the Hoorn Study

PurposeData on the relation between linoleic acid (LA) and alpha-linolenic acid (ALA) and type 2 diabetes mellitus (T2DM) risk are scarce and inconsistent. The aim of this study was to investigate the association of serum LA and ALA with fasting and 2 h post-load plasma glucose and glycated hemoglobin (HbA1c).MethodThis study included 667 participants from third examination (2000) of the population-based Hoorn study in which individuals with glucose intolerance were overrepresented. Fatty acid profiles in serum total lipids were measured at baseline, in 2000. Diabetes risk markers were measured at baseline and follow-up in 2008. Linear regression models were used in cross-sectional and prospective analyses.ResultsIn cross-sectional analyses (n = 667), serum LA was inversely associated with plasma glucose, both in fasting conditions (B = −0.024 [−0.045, −0.002]) and 2 h after glucose tolerance test (B = −0.099 [−0.158, −0.039]), but not with HbA1c (B = 0.000 [−0.014, 0.013]), after adjustment for relevant factors. In prospective analyses (n = 257), serum LA was not associated with fasting (B = 0.003 [−0.019, 0.025]) or post-load glucose (B = −0.026 [−0.100, 0.049]). Furthermore, no significant associations were found between serum ALA and glucose metabolism in cross-sectional or prospective analyses.ConclusionsIn this study, serum LA was inversely associated with fasting and post-load glucose in cross-sectional, but not in prospective analyses. Further studies are needed to elucidate the exact role of serum LA and ALA levels and dietary polyunsaturated fatty acids in glucose metabolism.

Chronic respiratory symptoms associated with airway wall thickening measured by thin-slice low-dose CT.

In lung cancer screening, the prevalence of chronic respiratory symptoms is high among heavy smokers. The purpose of this study was to compare CT-derived airway wall measurements between male smokers with and those without chronic respiratory symptoms. Fifty male heavy smokers with chronic respiratory symptoms (cough, excessive mucus secretion, dyspnea, and wheezing) and 50 without any respiratory symptom were randomly selected from the Dutch-Belgian Randomized Lung Cancer Screening Trial. Thin-slice low-dose CT images were evaluated with dedicated software for airway measurements. Wall area percentage and airway wall thickness were measured from trachea to bronchi in five different pulmonary lobes of airways with a luminal diameter of 5 mm or greater. Association between airway wall measurements and respiratory symptoms was analyzed by multiple linear regression adjusted for age, body mass index, smoking status, emphysema, and pulmonary function. After adjustment for relevant factors, a significant positive association between airway wall measurements and respiratory symptoms was found in airways with a luminal diameter between 5 to 10 mm (p < 0.01), but not in airways measuring 10 mm or greater (p > 0.05). At the airway level between 5 to 10 mm, the mean wall area percentages were 51.5% ± 7.9%. Airway wall thicknesses were 1.54 ± 0.39 mm and 1.37 ± 0.35 mm (p < 0.001). Male heavy smokers with chronic respiratory symptoms in lung cancer screening, who are at high-risk of chronic bronchitis, have bronchial wall thickening in airways with a luminal diameter of 5-10 mm but not in larger airways.