Age-adjusted Research Articles

Increased sodium consumption is associated with psoriasis: Apopulation-based cohort study.

Sodium is stored in skin and may trigger or perpetuate autoimmune diseases including psoriasis. One previous study found skin sodium was elevated in a small group of patients with severe psoriasis compared to healthy controls, but the relationship between sodium intake and psoriasis within a population has not been investigated. To identify whether dietary sodium intake is associated with psoriasis and whether there are subgroups of individuals more likely to have salt-sensitive psoriasis. This cross-sectional, population-based study evaluated a UK Biobank cohort of nearly 500,000 participants in the 2006-2010 period and a US-based National Health and Nutrition Examination Survey (NHANES) validation cohort of 2393 participants in the 2003-2004 period. Dietary sodium intake, the exposure, was estimated using urine biomarkers and the previously validated INTERSALT equation. Psoriasis outcome was assessed by the presence of ICD-10 code L40. In the UK Biobank, of the 468,913 included participants, 54% were female and mean (standard deviation) age at recruitment was 57 (8) years. Multivariable logistic regression models revealed that every 1 g increase in estimated 24-h urine sodium was associated with an 18% increase in odds of psoriasis (OR 1.18, 95% CI: 1.14-1.21) after adjustment for sex, age, race/ethnicity, education and socioeconomic status. There was no consistent evidence of large effect modification by age, sex, race/ethnicity, polygenic risk score for psoriasis or those with a history of hypertension, chronic renal failure or type 2 diabetes mellitus. In NHANES, each additional gram of self-reported dietary sodium intake was also associated with increased odds of examination-confirmed psoriasis (OR: 1.47, 95% CI: 1.19-1.83). Increased sodium intake was associated with psoriasis in two population-based cohorts; future clinical trials could investigate whether decreasing sodium intake improves psoriasis.

The prevalence of food addiction and its association with type 2 diabetes: a systematic review with meta-analysis.

To determine the prevalence of FA in individuals with type 2 diabetes and to assess the association between FA and type 2 diabetes. MEDLINE, EMBASE, Web of Sciences, Latin American and Caribbean Literature in Health Sciences, ScienceDirect, Scopus, and PsycINFO were searched until November 2024. This study was registered with PROSPERO (CRD42023465903). Cross-sectional studies, case-control, cohorts, and clinical trials that were carried out with individuals with type 2 diabetes, regardless of age and sex, were included. The complete data extracted included the prevalence, odds ratio, and/or risk ratio of FA, the number of individuals evaluated, age, sex, weight, presence of comorbidities, age of participants, and FA symptoms. A pooled prevalence of FA of 30% (95% CI [18; 44] with estimated predictive interval [0; 85]; I2 = 99.51; 12 studies; 15947 participants) was identified. For the associations between FA and type 2 diabetes, we found a grouped crude odds ratio value of 2.35 (95%CI [1.71; 2.98]). The pooled odds ratio adjusted for age and sex was 2.60 (95% CI [1.77; 3.42]). Finally, the odds ratio adjusted for age, sex, and body mass index (BMI) was 2.01 (95%CI [1.39; 2.64]). The results of the meta-analyses showed a high prevalence of FA in individuals with type 2 diabetes and that the associations between these two conditions remained even after adjustment for age, sex, and BMI, although with a high heterogeneity among individual estimates.

The association of physical function and physical performance with DNA methylation clocks in oldest-old living in Singapore - the SG90 cohort.

Deoxyribonucleic acid (DNA) methylation (DNAm) clocks estimate biological age according to DNA methylation. This study investigated the associations between measures of physical function and physical performance and ten DNAm clocks in the oldest-old in Singapore. The SG90 cohort included a subset of community-dwelling oldest-old from the Singapore Chinese Health Study (SCHS) and Singapore Longitudinal Ageing Study (SLAS). Physical function and performance were assessed using Basic Activities of Daily Living (BADL), Instrumental Activities of Daily Living (IADL), World Health Organization Disability Assessment Schedule (WHODAS), Short Physical Performance Battery (SPPB), Timed Up and Go (TUG), handgrip strength, normal gait speed, SPPB fast gait speed (FGS), and. DNAm age from peripheral blood mononuclear cells (PBMC) was measured using 18 DNAm clocks, including first generation clocks (PCHorvath1, PCHorvath2, PCHannum, AltumAge, ENCen100+, ENCEN40+, IntrinClock, RetroAgev1 and RetroAgev2) second and third generation clocks (PCPhenoAge, PCGrimAge, GrimAge2, ZhangMRscore, DNAmFitAge and DunedinPACE) and causality-enriched clocks (YingCausAge, YingAdaptAge, YingDamAge). Linear regression was used to analyse associations. The 433 oldest-old individuals had a median age of 88.6 years [87.5; 90.4] and were predominantly Chinese (95.6%) and female (60.3%). Better performance in IADL, WHODAS, SPPB, SPPB FGS and balance were associated with lower GrimAge2 after adjustment for age, sex, and smoking status (pAdj<0.05). GrimAge2 outperformed other DNAm clocks after adjustment for DNAm smoking-pack-years and DNAm-based cell compositions. Better physical function and physical performance were associated with lower DNAm age deviation and pace of ageing. Longitudinal and intervention studies are needed to explore biological mechanisms underlying these observed associations.

Myocardial Inflammation in Cardiac Transthyretin Amyloidosis: Prevalence and Potential Prognostic Implications.

Despite previous histopathologic evidence for its presence, the role of myocardial inflammation in the development and progression of cardiac transthyretin amyloidosis (ATTR-CA) remains insufficiently understood. Thus, this study sought to characterize the prevalence and potential prognostic implications of myocardial inflammation in ATTR-CA. A retrospective observational study including patients with ATTR-CA diagnosed by endomyocardial biopsy was conducted. Myocardial inflammation was diagnosed through a review of routine endomyocardial biopsy reports. Baseline characteristics were compared using the Mann-Whitney U test and the Pearson χ2 test. Clinical outcomes were monitored via follow-up visits or telephone calls. Primary outcomes were all-cause death and a composite end point of all-cause death or heart failure hospitalization. Kaplan-Meier analyses, as well as univariable and age- and sex-adjusted multivariable Cox regression analyses, were used to assess differences in overall and composite end point-free survival between patients with ATTR-CA with and without myocardial inflammation. A total of 103 patients with ATTR-CA (100 wild type; 3 variant) were enrolled. Median follow-up was 18.2 (8.0-31.1) months. Myocardial inflammation was prevalent in 32% (n=33/103) of patients with ATTR-CA. Among evaluable patients with myocardial inflammation, 96% (n=26/27) and 31% (n=9/29) had elevated CD68 (clusters of differentiation 68)-positive macrophage and CD3 (clusters of differentiation 3)-positive T-cell counts, respectively. Overall survival (P=0.017) and composite end point-free survival (P=0.014) were significantly impaired in patients with ATTR-CA with myocardial inflammation (n=33) compared with those without (n=70). Statistical significance for both associations was sustained after adjustment for age and sex, yielding adjusted hazard ratios of 4.72 (95% CI, 1.33-16.71; P=0.016) and 2.30 (95% CI, 1.04-5.11; P=0.041) for all-cause death and the composite end point, respectively. Our findings affirm previous evidence that myocardial inflammation is present in approximately one-third of all patients with ATTR-CA. Moreover, we provide first data indicating that myocardial inflammation may be associated with a higher risk of death and heart failure hospitalizations in ATTR-CA.

Estimates and trends in death and disability from atrial fibrillation/atrial flutter due to high sodium intake, China, 1990 to 2019

ObjectiveThe effect of sodium intake on atrial fibrillation (AF)/atrial flutter (AFL), with respect to sex and age, has yet to be elucidated. This study aims to compare long-term trends in AF/AFL death and disability due to high sodium intake in China from 1990 to 2019.MethodsWe utilized data from the Global Burden of Disease study to assess the mortality and disability burden of AF/AFL attributable to high sodium intake (> 5 g/d) in China from 1990 to 2019. Overtime trends and average annual percentage change (AAPC) were analyzed with adjustments for age, sex, period, and cohorts.ResultsIn 2019, the number of AF/AFL deaths and disability-adjusted life years attributable to high sodium intake were 4209.944 (95% UI: [1250.690-8718.238]) and 235484.586 (95% UI: [89136.783-428566.694]), with males comprising 44.81% and 51.95% of cases, respectively. The age-standardized mortality rates (ASMRs) and age-standardized disability rates (ASDRs) of AF/AFL attributable to high sodium intake exhibited downward trends from 1990 to 2019 in China. The AAPC was − 0.221(95% CI: -0.321–0.121)and − 0.631(95% CI: -0.816–0.446) for AF/AFL, respectively. An upward trend was observed in ASMRs for AF and AFL, attributable to high sodium intake due to high salt intake at ages 30–34, 35–39, and 40–44. With an increase in age, the AAPC for ASMRs increased correspondingly, and the AAPC for ASDRs exhibited a decreasing trend.ConclusionsOur findings provide strong evidence that high sodium levels in China significantly affect standard ASMRs and ASDRs for AF and AFL. Notably, different patterns of change are identified across various age groups, emphasizing the pronounced effect of salt reduction on AF and AFL.

Trabecular bone deficits predominate in the appendicular skeleton of midlife women living with HIV: findings from a cross-sectional study in Zimbabwe.

HIV-related mortality has fallen due to scale-up of antiretroviral therapy (ART), so more women living with HIV (WLH) now live to reach menopause. Menopausal estrogen loss causes bone loss, as do HIV and certain ART regimens. However, quantitative bone data from WLH are few in Africa. A cross-sectional study of women aged 40-60years (49% WLH) was conducted in Harare, Zimbabwe. Menopause status, fracture history, HIV status and treatment, and anthropometry were collected, and radial/tibial peripheral Quantitative Computed Tomography (pQCT) scans performed. pQCT outcomes were: distal radius and tibia trabecular volumetric bone mineral density (vBMD), total area, and compressive bone strength (BSIc); proximal radius and tibia cortical vBMD, bone mineral content (BMC), cortical thickness, bone area, and stress-strain index (SSI). Linear regression determined differences by HIV status, minimally adjusted for age and menopause status, and further adjusted for height and fat mass. Relationships between pQCT parameters and major osteoporotic fracture history were explored using univariate logistic regression. In WLH, linear regression assessed associations between HIV and ART durations on pQCT measures. 384 women mean(SD) age 49.7(5.8) years had pQCT data. WLH had lower absolute pQCT measures at all sites. Overall, HIV-related deficits were robust to adjustment for age, menopause status, height, and fat mass: WLH had lower trabecular vBMD (radius -7.3 [-12.5; -2.0]%, tibia -5.4 [-9.1; -1.7]%), and cortical vBMD (radius -3.5 [-5.9; -1.1]%, tibia -1.1[-1.6; -0.5]%). Strength estimates were lower in WLH and of similar magnitude at the radius and tibia. Longer HIV duration was associated with lower radius bone area, BMC, estimates of bone strength, independent of ART duration. Trabecular deficits predominate in WLH, though with age cortical compartment bone loss may increase in importance. This is particularly concerning as these differences were observed at the radius, a common site of postmenopausal osteoporotic fracture.

Decreased serum PF4 levels correlate with cognitive decline and CSF biomarkers in Alzheimer's disease in a Chinese cohort.

Platelet factor 4 (PF4), a chemotactic factor secreted from the α-granules of platelets, has recently been proved to mitigate neuroinflammation and improve aging-related cognition decline, which may be involved in Alzheimer's disease (AD). This study aims to investigate the alterations of serum PF4 levels in AD, the correlation between serum PF4 and β-amyloid (Aβ) and tau levels in cerebrospinal fluid (CSF), and the potential diagnostic utility of PF4 in AD. A cross-sectional study was conducted involving 38 amyloid-positive AD patients and 50 cognitively normal controls. The levels of serum PF4 were detected using the Human CXCL4/PF4 enzyme-linked immunosorbent assay (ELISA) Kit. The levels of CSF Aβ42, Aβ40, p-tau181, and t-tau were measured on the fully-automated Lumipulse G1200 platform via commercially available kits. The levels of serum PF4 were significantly decreased in AD patients (5163.51 (3198.24-6301.15) vs. 5859.29 (4126.06-8006.70), Z=-2.30, P=0.021). The negative correlation between AD diagnosis (β=-1972.292, P=0.009) and PF4 levels retained after the adjustments of age, sex, APOE ε4 status, platelet count, platelet distribution width (PDW), and comorbidity of dyslipidemia in the multiple linear regression analysis. Further analysis showed that serum PF4 levels were positively correlated with CSF Aβ42 levels and Mini-Mental State Examination (MMSE) scores, and negatively correlated with CSF t-tau levels. Besides, the area under the curve (AUC) of serum PF4 for AD (AUC=0.6437, P=0.022) was comparable to that of CSF Aβ40 (AUC=0.6400) yet lower than those of CSF Aβ42, ptau181, and t-tau. The AUC slightly increased when combining serum PF4 with other CSF AD biomarkers separately. The serum levels of PF4 were decreased in AD patients and were significantly correlated with the cognitive function and CSF levels of Aβ42 and t-tau. PF4 may become a promising anti-aging and therapeutic target for AD, which is worthy of further study.

P1210 Risk of post-acute sequalae of COVID-19 in patients with immune-mediated inflammatory diseases

Abstract Background Evidence suggest that about 10-30% of individuals with COVID-19 develop a chronic condition following the acute phase, now referred to as the post-acute sequalae of COVID-19 (PASC) or long COVID1,2. Dysregulation of the immune system and chronic inflammation, which are among the primary drivers of PASC3, are at the heart of immune-mediated inflammatory disease (IMID) pathology. As PASC still remains underexplored in the IMID population, we aimed to carry out a population-based cohort study to estimate the risk of PASC in patients with IMIDs compared to those without a recorded diagnosis of an IMID. Methods We used the Danish national registers to identify all individuals with a recorded positive SARS-CoV-2 test between 01 January 2020 and 01 January 2022. Individuals with IMIDs including Crohn’s disease (CD), ulcerative colitis (UC), hidradenitis suppurativa (HS), rheumatoid arthritis (RA), spondylarthritis (SpA), and psoriasis were identified using ICD-10 codes and medication with indication (only for psoriasis) before 01 January 2020. The IMID and non-IMID groups were matched (1:2) on age, sex, municipality of residence, and calendar period. With the first positive date as index, individuals were followed up until a PASC diagnosis, emigration, death or end of the study period (31 July 2022), whichever is earliest. If an individual from the non-IMID group is diagnosed with an IMID, they are censored. Cox proportional hazard regression was carried out to estimate hazard ratios (HRs) with adjustments for age, sex and Charlson Comorbidity Index in all analyses. Subgroup analysis by vaccination status, hospitalization for COVID-19, IMID medication, IMID group, and SARS-CoV-2 variant were carried out. Results We compared 25,889 IMID patients to 51,778 individuals without an IMID for the risk of PASC. The median age was 48 (IQR: 35, 61) and 56% were women. Psoriasis was the largest group constituting 47% of the IMID group. During a median follow-up of 7.7(IQR:7.1-16.3) months, a total of 753 cases of PASC were reported in the entire cohort. The Cox proportional hazard regression showed an increased risk of PASC in the IMID group (HR: 1.51, 95% CI: (1.30-1.74)) compared to the non-IMID group. SpA (HR: 1.91, 95% CI:(1.21-3.01)), RA (HR: 1.72, 95% CI:(1.25-2.37)) and psoriasis (HR: 1.50, 95% CI:(1.21-1.85)) were individually associated with an increased risk of PASC. Conclusion This cohort study using nationwide registers showed an increased risk of PASC in individuals with an IMID and in spondylarthritis, rheumatoid arthritis and psoriasis individually. The results underline the need for clinicians to be aware of the chronic impact of early SARS-CoV-2 infection that IMID patients are living with at present.

P0248 Insomnia as a determinant of poor IBD disease course

Abstract Background Insomnia is one of the most common sleep disorders, affecting up to 30% of the adult population worldwide. Sleep disorders can have a marked impact on immune functions and inflammation, including in patients with inflammatory bowel diseases (IBD) in both active and inactive disease states. Whether insomnia preceding IBD flares affects clinical outcomes is unknown. We examined the association between insomnia and IBD-related outcomes in adults diagnosed with of Crohn’s disease (CD) or ulcerative colitis (UC). Methods A retrospective, real-world, cohort study utilizing the Lynx MD’s electronic medical record dataset, provided by a US-based community gastroenterology practice. Deidentified patient charts were analyzed to identify patients with a confirmed diagnosis of IBD (either CD or UC). Eligibility criteria included: ≥3 diagnoses of IBD, ≥1 diagnoses of IBD and: histopathologic diagnosis of IBD; or IBD related surgery; or ≥ 3 months of treatment with standard accepted therapies for IBD; and ≥3 years of follow-up. IBD-related events of hospitalization and/or surgery were recorded. The cohort was classified into two groups based on insomnia diagnosis, prior to IBD related hospitalizations or surgeries. We implemented Cox Proportional Regression models to estimate Hazard Ratios for the IBD-related outcomes. Results Among 20,011 patients with IBD, 10,775 (54%) were women, at a mean age of 48.2 ± 18.2 years old, 11,842 (59%) were diagnosed with UC and 8,169 (41%) with CD. Over 3,100 patients (16%) were diagnosed with insomnia prior to the first IBD related hospitalization or surgery. In an unadjusted model, insomnia was significantly associated with IBD-related hospitalizations - hazard ratio (HR) of 1.43 (95% CI 1.28, 1.59) and IBD related surgeries - HR of 1.42 (95% CI 1.12, 1.81). After adjustment for age, sex, race, body mass index, anxiety and type of IBD (CD vs. UC), IBD-affected patients with insomnia had a higher HR of hospitalization and surgery: HR of 1.35 (95% CI 1.2,1.51) and 1.29 (95% CI 1.01,1.66), respectively, compared to those without insomnia. Conclusion In a large real-life dataset of patients with IBD, we found higher rates of IBD-related hospitalizations and surgeries among patients with comorbid insomnia, suggesting that insomnia may be associated with a more severe course of IBD.

The simpler modified fried frailty scale predicts 2-year mortality in older adults with heart failure: a pilot study

ObjectiveThe Simpler Modified Fried Frailty Scale (SMFFS) has recently been developed from the original Fried scale to ease its use in clinical practice, by transforming the items requiring measurements into the self-reported inquiries. Its predictive validity needs to be clarified, especially in populations with a high prevalence of frailty, such as patients with heart failure (HF). Primary aim of this study is to find out the prevalence of frailty in older patients with HF by using SMFFS and show its concordance with other frailty assessment tools. Secondary aim is to reveal whether SMFFS is useful to predict mortality in follow-up.MethodThis is a prospective, follow-up study including older adults (≥ 65 years) with HF. SMFFS was used to assess frailty phenotype and presence of ≥ 3 items was accepted as frailty. FRAIL scale, the Study of Osteoporosis Fractures (SOF) index, and Edmonton Frailty Scale (EFS) were alternatively used to study the correlation of SMFFS with different scales. Cox-regression analysis was performed to identify whether SMFFS-defined frailty could predict mortality in follow-up, with adjusting for a list of clinical characteristics and geriatric syndromes.FindingsAmong 101 patients with HF, 44 (42.8%) were female. Mean age was 75.8 ± 7.6 and frailty prevalence was 63.4% according to SMFFS. SMFFS showed a strong correlation with the other frailty scales. In a median follow-up of 759 days, cardiomegaly, increased pulmonary artery pressure (PAP) and frailty defined by SMFFS were the only predictors of mortality in older adults with HF after adjustments for age, falls in the previous year, undernutrition, probable sarcopenia, functional impairments, and quality of life [HR (95% CI) were 3.88 (1.05–14.3), 1.05 (1.01–1.09), and 10.96 (1.07–112.05) (p = 0.027); for older age, PAP, and frailty, respectively].ConclusionsAs a self-reported screening tool, SMFFS was independently associated with mortality in a median follow-up of two years. Frailty assessment recommended by the guidelines for risk stratification in patients with HF seems to be more effectively integrated into routine HF practice with the use of the easy and practical SMFFS. Further large scale studies are needed to support the predictive validity of SMFFS in older patients with HF.

Associations of dietary oxidative balance score with sarcopenia in adults: an NHANES-based cross-sectional study

BackgroundSarcopenia, a prevalent muscle disorder in the older adults, is characterized by accelerated loss of muscle mass and function, contributing to increased risks of falls, functional decline, and mortality. The relationship between dietary oxidative balance score (DOBS) and sarcopenia, however, remains unclear.MethodsWe conducted a cross-sectional analysis of the National Health and Nutritional Examination Survey (NHANES) 2011–2018 cohort, which included 8,240 participants, aged 47.2 ± 17.6 years (48.6% male, 51.4% female). The participants were selected from geographic locations across all 50 states and the District of Columbia, using a stratified, multistage probability sampling design to collect health and nutritional data representative of the civilian, non-institutionalized U.S. population. We employed the generalized additive model to identify potential non-linear relationships and utilized the two-piecewise linear regression model to investigate the association between DOBS and sarcopenia in American adults.ResultsParticipants were categorized into quartiles based on their DOBS, and sarcopenia was diagnosed in 702 individuals (8.5%). In the unadjusted model, DOBS exhibited a significant negative correlation with sarcopenia (β = 0.97, 95% Confidence Interval (CI): 0.96 to 0.99, P < 0.001). This association remained consistent in the model with minimal adjustment for age and gender (β = 0.97, 95% CI: 0.96 to 0.98, P < 0.001) and in the fully adjusted model including additional covariates (β = 0.97, 95% CI: 0.96 to 0.99, P < 0.001). After adjusting for potential confounders, we identified a non-linear association DOBS and sarcopenia, with an inflection point at 23. The effect sizes and CIs to the left and right of the inflection point were 1.62 (95% CI: 1.09 to 2.41, P = 0.016) and 0.97 (95% CI: 0.95 to 0.98, P < 0.001), respectively. Subgroup analyses confirmed the stability of this relationship across various demographic and health-related variables.ConclusionsThis research provides new insights into the association between diet quality, as assessed by DOBS, and sarcopenia, reinforcing the critical role of a balanced, antioxidant-rich diet in adult muscle.

Glomerular diameter is associated with a reduction in urinary protein by treatment with dapagliflozin in patients with chronic kidney disease.

Several clinical trials showed that sodium-glucose cotransporter 2 (SGLT2) inhibitors have protective effects against chronic kidney disease (CKD) in both patients with and those without type 2 diabetes mellitus. Since one of the renoprotective mechanisms of SGLT2 inhibitors is thought to be amelioration of glomerular hyperfiltration, we hypothesized that an enlarged glomerular diameter, which suggests increased single-nephron glomerular filtration rate, is associated with a reduction in urinary protein after treatment with an SGLT2 inhibitor. This study was a retrospective multicentered study including 28 adult patients with CKD who underwent kidney biopsy and were then treated with dapagliflozin, an SGLT2 inhibitor. The association of glomerular diameter with changes in urinary protein 4-8 weeks after the initiation of treatment with dapagliflozin was investigated. Maximum glomerular diameter was significantly and positively correlated with change in urinary protein-to-creatinine ratio (UPCR) (R2 = 0.44; P < 0.001). Maximum glomerular diameter was significantly larger in patients who achieved ≥ 30% reduction in UPCR after the initiation of treatment with dapagliflozin than in patients who achieved < 30% reduction in UPCR (219.4 ± 23.9 vs. 188.0 ± 29.0; P = 0.005). After adjustment of age, sex and estimated glomerular filtration rate, maximum glomerular diameter was independently associated with change in UPCR (β = 0.645, P < 0.001). Furthermore, maximum glomerular diameter was independently associated with ≥ 30% reduction in UPCR (odds ratio: 1.07, 95% confidential interval: 1.01-1.14). Glomerular diameter is independently associated with an early change in UPCR after the initiation of treatment with dapagliflozin in patients with CKD.

Relationship of maternal ophthalmic artery Doppler with uterine artery Doppler, hemodynamic indices and gestational age: prospective MATERA study.

To examine the relationship of ophthalmic artery (OA) Doppler indices with uterine artery (UtA) Doppler indices, selected maternal hemodynamic parameters and gestational age, and to evaluate the intraobserver reproducibility of OA Doppler indices. This was a prospective cohort study of women recruited between 11 + 0 and 23 + 6 weeks' gestation using a stratified and random sampling approach to ensure adequate distribution across the gestational-age range. OA pulsatility index (PI), first peak systolic velocity (PSV1), second peak systolic velocity (PSV2) and peak systolic velocity ratio (PSV ratio), calculated as PSV2/PSV1, were measured twice in each eye by the same observer. UtA-PI was also measured twice on each side by the same observer. Maternal hemodynamic assessment was undertaken using an ultrasonic cardiac output monitor (USCOM 1A). Pearson's and Spearman's rank correlation coefficients were used to assess the correlations between variables, and Bland-Altman plots were used to evaluate the intraobserver reproducibility of OA Doppler indices. Of 194 women invited to participate in the study, 169 were eligible for inclusion, of whom 16 were excluded following an obstetric ultrasound scan and a further three owing to inadequate or incomplete OA or UtA Doppler assessment, leaving 150 women in the final analysis. Log UtA-PI had a weak correlation with both OA-PI (r = -0.19 (95% CI, -0.34 to -0.03), P = 0.021) and OA-PSV ratio (r = 0.31 (95% CI, 0.15-0.45), P < 0.001). The correlation between gestational age and OA-PI was non-significant (r = 0.14 (95% CI, -0.03 to 0.29), P = 0.097), and that between gestational age and OA-PSV ratio was weak (r = -0.23 (95% CI, -0.38 to -0.07), P = 0.004), as opposed to the strong correlation between gestational age and UtA-PI (r = -0.68 (95% CI, -0.76 to -0.58), P < 0.001). No strong correlations were observed between OA-PI or OA-PSV ratio and maternal hemodynamic indices. The correlations were unaltered by adjustment for maternal age and body mass index. The intraobserver reproducibility of OA-PI and OA-PSV ratio in the same eye was high. The correlation between the right and left eyes was moderate for OA-PI (r = 0.63 (95% CI, 0.53-0.72), P < 0.001) and strong for OA-PSV ratio (r = 0.81 (95% CI, 0.75-0.86), P < 0.001). OA-PI and OA-PSV ratio had a weak or no correlation with UtA-PI and maternal hemodynamic parameters, meaning that they can be used as independent predictors for pre-eclampsia. Gestational age had no clinically relevant effect on OA-PI and OA-PSV ratio, suggesting that these indices could be measured without adjustment at any time between 11 and 23 weeks' gestation. OA Doppler indices had high intraobserver reproducibility and were strongly correlated between the right and left eyes. © 2025 The Author(s). Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

Association between Admission Blood Glucose and In-Hospital MACE in Non-Diabetic STEMI (Killip I) Patients Undergoing Primary PCI

Background: The increase in major adverse cardiovascular events (MACE) in patients with diabetes after primary percutaneous coronary intervention (pPCI) is significantly correlated with the admission blood glucose (ABG). However, it is unclear whether ABG in non-diabetic patients is related to MACE after pPCI. We aimed to explore the relationship between ABG and in-hospital MACE in non-diabetic ST-segment elevation myocardial infarction (STEMI) patients with Killip class I treated with pPCI. Methods: The Chinese STEMI pPCI Registry (NCT04996901) enrolled 5586 STEMI patients undergoing pPCI from January 2015 to August 2021. Patients were divided into three groups after excluding those with hyperglycemia (ABG ≥11 mmol/L) and a history of diabetes. MACE was defined by re-infarction, stroke, and cardiovascular death. The association between ABG and in-hospital MACE was assessed using Logistic regression analysis. Results: 2890 non-diabetic STEMI patients with Killip class I treated with pPCI were identified. Patients were divided into three groups based on ABG (Q1: 2.5–5.72 mmol/L; Q2: 5.73–7.0 mmol/L; Q3: 7.01–11.0 mmol/L). After multivariate adjustment for age, gender, Diastolic Blood Pressure (DBP), Heart Rate (HR), smoking, and hypertension, the OR of MACE in Q2 and Q3 were 1.43–1.62 times of Q1 in the calibration Model II to IV. Subgroup analysis showed that the OR of Q2 was 3.52-fold of Q1 in females and 1.54-fold in the elder (≥60 years). Sensitivity analysis showed that after excluding patients with ABG less than 4 mmol/L, elevated ABG was still associated with a significant increase in the risk of MACE. The area under the ROC curve of ABG in predicting the occurrence of MACE after pPCI was 0.668, and the C-index was 0.666. The cubic spline confirmed MACE risk decreased significantly with ABG below 6.3 mmol/L. Conclusions: Elevated ABG is associated with increased risk of in-hospital MACE in non-diabetic STEMI patients treated with pPCI, particularly females and the elderly. This retrospective observational study was registered in Clinical Trials (NCT04996901).

Longitudinal Outcomes of Patients with Aortic Stenosis Stratified by Sex: An Asian Perspective.

Severe aortic stenosis (AS) stratified by sex has been increasingly studied in the European population. Sex-specific outcomes in Asian patients with AS remain poorly defined. Hence, we aimed to study the clinical characteristics and impact of sex in moderate-to-severe AS, undergoing both invasive and conservative interventions in an Asian cohort over 10 years. Consecutive data with echocardiographic diagnoses of AS were stratified according to gender in a tertiary academic center between 2011 and 2021. Demographics, comorbidities, and clinical outcomes were compared. Seven hundred and three (703) patients were included (56%, n = 397 were female). Calcific AS was the dominant etiology in both genders. Females had higher incidences of anemia (p < 0.001) and chronic kidney disease (p = 0.026); although, females had lower incidences of cardiovascular complications of coronary artery disease (CAD) (p = 0.002) and prior acute myocardial infarction (AMI) (p = 0.015). Echocardiographically, females had a smaller left ventricular outflow tract diameter (LVOTd) (p < 0.001), LV mass (p < 0.001), and left ventricle end diastolic volume (LVEDV) (p < 0.001). Conversely, the left atrial (LA) area (p < 0.001) and volume index (LAVI) (p < 0.001) were larger in females. Females had higher average E/e' (p = 0.010) ratios compared to males. The mean follow-up duration between genders was 4.1 ± 3.3 years. Upon univariate analysis, a greater proportion of female AS patients encountered cardiovascular (CV) hospitalization during follow-up (female: 27.5%, n = 109 vs. male: 18.3%, n = 56; p = 0.005) compared to male patients, but there were no significant differences for the outcomes of heart failure (p = 0.612), stroke (p = 0.664), and all-cause mortality (p = 0.827). Fewer females underwent aortic valve (AV) intervention compared to males (21.2% vs. 27.8%, p = 0.042), albeit with a longer duration to AV intervention (3.6 years ± 2.4 vs. 2.6 years ± 2.3, p = 0.016). In the severe AS cohort, female sex remained an independent predictor for subsequent heart failure (aHR 2.89, 95% CI 1.01-8.29, p = 0.048) and CV hospitalization (aHR 20.0, 95% CI 1.19-335, p = 0.037) after adjustments for age, ethnicity, body mass index (BMI), comorbidities, left ventricular ejection fraction (LVEF), and AV intervention. There was no difference in heart failure, stroke, and all-cause mortality outcomes between male and female Asian patients with moderate-to-severe AS. However, there were more cardiovascular hospitalizations, with fewer and longer duration to AV intervention in females compared to males in our cohort.

Immunosuppression and Outcomes in Patients with Cutaneous Squamous Cell Carcinoma of the Head and Neck.

Cutaneous squamous scell carcinoma (cSCC) is a frequent non-melanoma skin cancer that originates from keratinocytes with increased prevalence. cSCC can be either in situ, as in Bowen's disease, or extended. Advanced age, accumulated sun exposure, light pigmentation, and prior skin cancer diagnosis are all significant risk factors for cSCC. Although most cSCCs can be treated surgically, some recur and metastasize, resulting in death. The role of immune status is not yet determined in the prognosis of these patients. Objective. Immunosuppressed patients are more likely to develop cSCC, which is often characterized by more aggressive, multifocal lesions. This study aimed to determine the risks of mortality in patients with cSCC and immunosuppression versus non immunosuppression and to compare variations in overall survival based on different clinical features. Method. We evaluated clinical cases of patients at "Sfantul Apostol Andrei" Emergency Hospital of Galati, Romania, from 1 March 2018 to 1 April 2024. Subjects in the trial had to be at least 18 years old and have a pathologically confirmed diagnosis of cutaneous head and neck squamous cell carcinoma (cHNSCC). We divided the patients into two different categories based on whether they had immunosuppression. Results. In this cohort of 68 subjects with cSCC, patients with immunosuppression had significantly lower overall survival, as well as lower three- and five-year survival rates compared with those without immunosuppression, even after adjustment for age, sex, stage, and previous surgical treatment. The median survival time for immunosuppressed individuals ranged from 11 to 21 months, varying based on their particular characteristics, and most critically, on the presence of other malignancies, while that of immunocompetent patients ranged from 18 to 51 months. In addition, immune-deficient patients with early-stage disease had a 21-month median survival rate that changed to11 months for advanced-stage cases. In a similar manner, immunocompetent patients with early-stage cancer had a significantly better median survival than those withadvancedstages,43 versus 18months. Our results indicate that immunosuppression is a distinct risk factors associated with a less favorable outcome in patients with cHNSCC.

Severe sepsis-associated acute kidney injury and outcomes: a longitudinal cohort study.

Sepsis-associated acute kidney injury (SA-AKI) is common among patients admitted to the intensive care unit (ICU) with sepsis. This study aimed to demonstrate an association between an episode of SA-AKI and progression to dialysis dependence, with a view to identifying a cohort who may be suitable for intensive nephrology follow-up. Design: Retrospective data-linkage cohort study. Alice Springs Hospital ICU, 10-bed regional facility, housed in a 200-bed regional hospital, located in Central Australia. All patients admitted with a diagnosis code associated with sepsis between 2015 and 2017. Primary outcome was a composite measure comprising death or initiation of maintenance dialysis within 5 years of the index case of sepsis leading to ICU admission. The unadjusted risk of the composite outcome was significantly higher in the SA-AKI group (odds ratio (OR) 3.22, 95% confidence interval (CI) 1.81-5.74, P < 0.01). This effect remains after adjustment for age, illness severity and co-morbidities (adjusted OR (aOR) 2.64, 95% CI 1.22-5.68, P = 0.01). Progression to maintenance dialysis was the primary driver of this effect (OR 7.56, 95% CI 2.23-25.65, P = 0.02), although it was modified by the effect of confounders (aOR 7.3, 95% CI 0.7-75.94, P = 0.10). These results demonstrate an association between an index episode involving SA-AKI and the composite outcome in a defined population. Identification of this group may allow intensive nephrology follow-up and secondary prevention with the goal of mitigating the risk of progression of disease with significant economic and personal benefits.

Early menarche is associated with disordered eating-results from a National Youth Survey.

Disordered eating (DE) is highly prevalent among adolescents, though its definition varies. The association between DE and early pubertal maturation (EPM) remains underexplored in Israel, and has not been sufficiently examined using the widely-used SCOFF questionnaire. This study examines these associations in adolescents. Participants (n = 2415 girls, 2095 boys; ages 12-18 years) in a nationally-representative, cross-sectional Youth Health and Nutrition Survey (2015-2016) completed self-administered questionnaires, including the SCOFF questionnaire, and underwent anthropometric measurements. EPM was determined by menarcheal age <11.5 years in girls, and facial hair appearance <12.5 years in boys. Respondents affirming ≥2 SCOFF items were classified as DE cases. Multivariable logistic regression analyses examined the associations between EPM and DE. Among the participants, 12.7% of the girls and 20.4% of the boys met EPM criteria; 55.5% and 33.7%, respectively, were categorized as having DE. Following adjustment for age, socioeconomic status, ethnic background, and weight status, EPM was significantly associated with DE in girls (OR 1.47, 95%CI: 1.12-1.93) and with 3/5 SCOFF items. No such association was found in boys (OR 1.00, 95%CI: 0.77-1.28). EPM in girls was associated with DE. Identifying high risk groups for DE in adolescents is crucial for early intervention and prevention. This study included a large, nationally representative sample of Israeli adolescents and utilized the SCOFF questionnaire, a widely used screening measure for disordered eating (DE). Following comprehensive analyses, a significant association between early pubertal maturation (EPM), defined as early menarche, and DE was documented in Israeli adolescent girls. Identifying girls with EPM and screening for disordered eating will allow for early interventions, potentially improving physical and mental health, and preventing progression to eating disorders.

Differences in time to surgery and defect sizes after Mohs micrographic surgery for black versus white patients with cutaneous squamous cell carcinoma.

Few studies have examined outcomes for Mohs micrographic surgery (MMS) for cutaneous squamous cell carcinoma (cSCC) in Black versus White patients. We compared time to surgery and defect sizes after MMS between Black versus White patients with cSCC. Patients with biopsy-proven cSCC treated with MMS at the Hospital of the University of Pennsylvania were identified from a prospectively maintained database (2006-2023). Our primary outcomes included time to surgery (days from the diagnostic biopsy to the first MMS) and defect size (final MMS defect surface area). Univariate and multivariate linear regression models were performed to compare outcomes between Black and White patients with adjustments for age, gender, and tumor location. We identified 8445 cSCC, including 8329 (98.2%) in White patients and 116 (1.4%) in Black patients. Mean time to surgery was 31% longer for Black (76 ± 3.9 days) versus White patients (58 ± 0.5 days) [p < 0.001]. Mean post-MMS cSCC defect size was nearly four times larger for Black (18.6 ± 1.2 cm2) versus White patients (4.8 ± 0.1 cm2) [p < 0.0001]. These differences remained significant when adjusted for age, gender, and tumor location [p < 0.0001]. In conclusion, Black patients with cSCC have significantly longer treatment delays and larger MMS defects than White patients. This study highlights the need for earlier diagnosis and more timely access to MMS for Black patients with cSCC.

Associations of Social, Behavioral, and Clinical Factors With Sex Differences in Stroke Recurrence and Poststroke Mortality.

Few population-based studies have assessed sex differences in stroke recurrence. In addition, contributors to sex differences in recurrence and poststroke mortality, including social factors, are unclear. We investigated sex differences in these outcomes and the contribution of social, clinical, and behavioral factors to the sex differences. First-ever ischemic stroke cases identified from 2008 to 2019 from the population-based Brain Attack Surveillance in Corpus Christi Project in Texas were included and followed for recurrence and all-cause mortality through 2020. Sex differences in outcomes with and without adjustment for potential confounding factors, including social, behavioral, and clinical factors, were examined using Cox proportional hazard models. Factors that changed the log hazard ratio (HR) for sex by at least 10% after adjustment were identified as confounders/contributors. Final models were adjusted for all identified confounders. Of 2326 participants (mean age, 68 years; 48% women; 57% Mexican American), over median follow-ups of 5.4 years for recurrence and 3.7 years for mortality, 274 recurrences and 965 deaths occurred. No significant sex differences in recurrence were noted in unadjusted (HR, 0.89 [95% CI, 0.70-1.13]), age-adjusted (HR, 0.92 [95% CI, 0.72-1.18]), or fully adjusted models (HR, 0.88 [95% CI, 0.67-1.16]). Although women had a higher crude mortality rate than men (HR, 1.22 [95% CI, 1.08-1.38]), this sex difference disappeared after age adjustment (HR, 0.91 [95% CI, 0.80-1.03]). Other factors contributing to the sex difference included education, marital status, prestroke depression, health behaviors, initial stroke severity, prestroke disability, comorbidities, atrial fibrillation, and coronary artery disease. After simultaneously adjusting for all identified confounders, women had lower poststroke mortality (HR, 0.79 [95% CI, 0.68-0.91]). Sex differences in stroke recurrence were not apparent. Women had a higher unadjusted poststroke mortality rate but lower adjusted mortality than men. Social and psychosocial factors, alongside clinical factors, primarily explained the sex disparity in poststroke mortality.