Subgroup Analysis Research Articles

Analysis of treatment-free remission outcomes in patients with chronic myeloid leukemia who received sequential nilotinib therapy after achieving deep molecular response to imatinib

Objective: To analyze the treatment-free remission (TFR) outcomes in patients with chronic myeloid leukemia (CML) treated sequentially with nilotinib (NIL) after achieving deep molecular response (DMR) to imatinib (IM). Methods: Retrospectively enrolled 103 CML patients from 6 hematological centers in Henan Province who chose sequential NIL therapy or continued IM therapy after achieving DMR to first-line IM from June 2, 2013 to August 30, 2022. Among them, 42 cases were treated with sequential NIL and 61 cases continued IM therapy. The 42 patients in the sequential NIL group were further divided into 3 subgroups based on the duration of DMR at switching to sequential NIL therapy: Group 1 (17 cases): DMR duration<12 months at switching to sequential NIL therapy; Group 2 (8 cases): DMR duration≥12 months to<24 months at switching to sequential NIL therapy; Group 3 (17 cases): DMR duration≥24 months at switching to sequential NIL therapy. Follow-up ended on January 9, 2024, with a median follow-up of 40 (16, 91) months for the sequential NIL group and 49 (21, 123) months for the continuous IM group. Survival curves were plotted using the Kaplan-Meier method and the log-rank test was performed to compare the TFR rates between groups. Results: There were 19 males and 23 females with a median age [M (Q1, Q3)] of 43 (31, 50) years in the sequential NIL group. There were 32 males and 29 females with a median age of 41 (31, 50) years in the continuous IM group. Kaplan-Meier survival curve analysis showed that the TFR rate was higher in the sequential NIL group than in the continuous IM group (88.1% vs 63.9%, P=0.005). The results of subgroup analysis showed that the TFR rates in Group 1, Group 2 and Group 3 were 94.1%, 87.5% and 82.4%, respectively, with no statistically significant differences (all P>0.05).The TFR rate in Group 1 was higher than in the continued IM group (P=0.017), and there were no statistically significant differences in Group 2 and Group 3 compared with the continuous IM group(all P>0.05). Conclusion: Sequential NIL therapy after achieving DMR with IM therapy can improve the TFR rate in CML patients, especially in those with DMR duration<12 months before switching to sequential NIL therapy.

Longer-term effects of intermittent fasting on body composition and cardiometabolic health in adults with overweight and obesity: A systematic review and meta-analysis.

The aim of the present study was to investigate the effects of long-term intermittent fasting (IF) on body composition and cardiometabolic health in adults with overweight and obesity. PubMed, Web of Science, and Scopus were searched from inception to March 2024 to identify original randomized trials that investigated the effects of IF versus either a control diet (CON) and/or continuous caloric restriction (CR). Participants were adults with overweight and obesity and intervention durations were ≥ 6 months. Overall, a total of 24 studies involving 2032 participants were included in the meta-analysis. Compared with CON, IF significantly reduced body weight [WMD: -2.84 kg], BMI [WMD: -1.41 kg.m2], fat mass [WMD: -3.06 kg], fat-free mass [WMD: -0.81 kg], waist circumference [WMD: -3.85 cm], visceral fat [SMD: -0.37], fasting glucose [WMD: -0.14 mmol/l], triglycerides [WMD: -0.12 mmol/l], and diastolic blood pressure [WMD: -2.24 mmHg]. Conversely, IF significantly increased high-density lipoproteins [WMD: 0.04 mmol/l] when compared with CON, but had no effects on insulin, hemoglobin A1c%, total cholesterol, low-density lipoprotein, or systolic blood pressure. Compared with CR, IF significantly reduced fat mass [WMD: -0.70 kg], body fat percentage [WMD: -0.59%], and DBP [WMD: -0.91 mmHg], and increased HDL [WMD: 0.03 mmol/l], with no other significant effects. Subgroup analyses showed that the mode of IF and intervention duration were the primary moderators of IF effects on the markers. In adults with overweight or obesity, IF and CR are comparably effective for reducing body weight and adiposity, as well as for improving cardiometabolic health markers.

Take Two: Second Systolic Blood Pressure Provides Prognostic Information in Trauma

Abstract Introduction: An initial systolic blood pressure (SBP1) of &lt;110 mmHg has been shown to predict mortality. However, SBP1 may not reflect hemodynamic changes during initial resuscitation. We aimed to determine if the second recorded blood pressure (SBP2) could provide additional prognostic value. Methods: An 8-year retrospective chart review was performed including patients who underwent trauma activations at a single institution. The initial systolic blood pressure (SBP 1) and second systolic blood pressure (SBP 2) were analyzed. Difference between the first and second systolic blood pressure (ΔSBP) was defined as SBP2 − SBP1. The primary outcome was inhospital mortality, and the secondary outcome was receipt of ≥2 units of blood in the first 4 h of admission. Univariable analysis and logistic regression analysis were performed to assess the relationship of SBP2 and ΔSBP with the study outcomes. Regression model fit was assessed by the likelihood ratio test and Akaike information criterion. Results: Eight thousand seven hundred and ninety-eight patients were included with 12% and 13% presenting with SBP1 &lt;110 mmHg and SBP2 &lt;110 mmHg, respectively. Four hundred and six (5%) died and 327 (4%) received ≥2 units of blood in the first 4 h. The addition of ΔSBP to regression models improved model fit in explaining the primary and secondary outcomes. Subgroup analysis found that the addition of ΔSBP improved model fit for those with penetrating mechanism of injury and those with Injury Severity Score of ≥9, but not for those with blunt moderate or severe traumatic brain injury. Conclusion: SBP2 offers additional prognostic value in predicting trauma outcomes. Incorporating subsequent hemodynamic data during resuscitation beyond the initial SBP in trauma databases should be considered.

Weight-adjusted waist index associated with bone mineral density in rheumatoid arthritis patients: a cross-sectional study.

The research examined the association between weight-adjusted waist index (WWI) and bone mineral density (BMD) in individuals with rheumatoid arthritis, considering the impact of obesity on bone health. The association between WWI and BMD was examined utilizing weighted linear regression and smoothed curve fitting with data from NHANES 2005-2010, 2013-2014, and 2017-2018. Subgroup analysis verified the stability of the results. The study included a cohort of 983 rheumatoid arthritis patients. A significant negative correlation was found between WWI and BMD at the total femur, femoral neck, and lumbar spine (β = -0.03, 95% CI (-0.04, -0.02), p < 0.001; β = -0.02, 95% CI (-0.04, -0.01), p = 0.001; β = -0.04, 95% CI (-0.06, -0.02), p < 0.001). This negative association was not significantly influenced by factors like age, gender, race, education, PIR, diabetes, hypertension, sleep disorders, alcohol consumption, or smoking status (p > 0.05 for interaction). The findings indicate a negative correlation between WWI and BMD in the rheumatoid arthritis population. Key Points •A negative correlation was found between WWI and BMD at the total femur, femoral neck, and lumbar spine in the rheumatoid arthritis population.

Early onset and increasing disparities in neurodevelopmental delays from birth to age 6 in children from low socioeconomic backgrounds.

To analyze the complex relationship between socioeconomic status (SES) and neurodevelopmental achievements by investigating the temporal dynamics of these associations from birth to age 6. This retrospective cohort study was conducted over 6 years using population-based data from the National Health Insurance Service and integrated data from the National Health Screening Program for Infants and Children. Participants were children born between 2009 and 2011 in Korea without neurodevelopmental delays with potential developmental implications. We analyzed results from the Korean Developmental Screening Test, administered at age 6, which covered overall assessment and six domains of gross and fine motor function, cognition, language, sociality, and self-care. The secondary outcome was to determine when neurodevelopmental outcomes began after birth and how these differences changed over time. Of 276,167 individuals (49.2% males), 66,325, 138,980, and 60,862 had low, intermediate, and high SES, respectively. Neurodevelopmental delays observed across all developmental domains were more prevalent in the low-SES group than in the high-SES group. Disparities in neurodevelopment according to these statuses were apparent as early as age 2 and tended to increase over time (interaction, P < 0.001). The cognition and language domains exhibited the most substantial disparities between SES levels. These disparities persisted in subgroup analyses of sex, birthweight, head circumference, birth data, and breastfeeding variables. Low SES was significantly associated with an increased risk of adverse neurodevelopmental outcomes in preschool children, particularly those affecting cognitive and language domains. These differences manifested in early childhood and widened over time.

Perfluorohexyloctane ophthalmic solution for dry eye disease: pooled analysis of two phase 3 clinical trials

BackgroundDry eye disease (DED) is commonly caused by excessive tear film evaporation due to Meibomian gland dysfunction (MGD). There is a need for DED treatment options that address tear evaporation and benefit patients across a broad range of demographic and disease characteristics. This study evaluated treatment effects of perfluorohexyloctane ophthalmic drop (formerly NOV03) in the pooled dataset from 2 pivotal clinical trials in patients with DED associated with MGD, both in the overall population and in patient subgroups based on sex, age, and baseline severity of eye dryness.MethodsPooled data from 2 similarly designed, phase 3, randomized controlled trials (GOBI, MOJAVE) were analyzed. Patients aged ≥18 years with DED administered perfluorohexyloctane (n=614) or hypotonic (0.6% solution) saline control (n=603) four times daily for 8 weeks. Primary endpoints were total corneal fluorescein staining (tCFS) score (National Eye Institute scale, 0-15) and eye dryness visual analog scale (VAS) score (0-100). Efficacy was evaluated using analysis of covariance among patient subgroups (male and female, older [≥65 years] and younger [18 to &amp;lt;65 years], tCFS score &amp;lt;7 and ≥7, VAS eye dryness score &amp;lt;70 and ≥70, MGD score &amp;lt;7 and ≥7, Schirmer I test &amp;lt;10 mm and ≥10 mm).ResultsReductions in tCFS and VAS eye dryness scores were greater for perfluorohexyloctane versus control. In the overall patient population, least-squares mean treatment difference was −1.1 (95% CI: −1.41 to −0.79; p&amp;lt;0.0001) for tCFS and −9.0 (95% CI: −11.90 to −6.00; p&amp;lt;0.0001) for VAS eye dryness. Treatment favored perfluorohexyloctane over control in all patient subgroup analyses of tCFS and VAS eye dryness. Overall, the most common adverse event with perfluorohexyloctane was blurred vision (2.1% of patients), which was mild and transient.ConclusionsCompared with a hypotonic saline control, perfluorohexyloctane improved both the signs and symptoms of DED, including in patients with greater self-reported severity of eye dryness.Clinical trial registrationThis study represents an integrated analysis of 2 previous clinical trials: GOBI (ClinicalTrials.gov, NCT04139798) and MOJAVE (ClinicalTrials.gov, NCT04567329).

The Effect of Vitamin D Supplementation Post COVID-19 Infection and Related Outcomes: A Systematic Review and Meta-Analysis

Background: Vitamin D’s role in COVID-19 management remains controversial. This meta-analysis aimed to evaluate the efficacy of vitamin D supplementation in patients with SARS-CoV-2 infection, focusing on mortality, intensive care unit (ICU) admissions, intubation rates, and hospital length of stay (LOS). Methods: A systematic review of PubMed/MEDLINE, Scopus, Cochrane, and Google Scholar databases was conducted. Randomized controlled trials (RCTs) and analytical studies investigating vitamin D supplementation in COVID-19 patients were included. The meta-analysis was performed using STATA MP 18.5, employing random-effect or fixed-effect models based on heterogeneity. Results: Twenty-nine studies (twenty-one RCTs, eight analytical) were analyzed. Vitamin D supplementation significantly reduced ICU admissions (OR = 0.55, 95% CI: 0.37 to 0.79) in RCTs and analytical studies (OR = 0.35, 95% CI: 0.18 to 0.66). Intubation rates were significantly reduced in RCTs (OR = 0.50, 95% CI: 0.27 to 0.92). Mortality reduction was significant in analytical studies (OR = 0.45, 95% CI: 0.24 to 0.86) but not in RCTs (OR = 0.80, 95% CI: 0.61 to 1.04). Subgroup analyses revealed more pronounced effects in older patients and severe COVID-19 cases. LOS showed a non-significant reduction (mean difference = −0.62 days, 95% CI: −1.41 to 0.18). Conclusions: This meta-analysis suggests potential benefits of vitamin D supplementation in COVID-19 patients, particularly in reducing ICU admissions. However, the evidence varies across outcomes and patient subgroups. Discrepancies between RCTs and analytical studies highlight the need for further large-scale, well-designed trials accounting for baseline vitamin D status, standardized supplementation protocols, and patient characteristics to inform clinical guidelines for vitamin D use in COVID-19 management.

Antidepressant prescribing inequalities in people with comorbid depression and type 2 diabetes: A UK primary care electronic health record study.

To compare the likelihood of being prescribed an antidepressant in depressed individuals with and without type 2 diabetes. We performed a matched cohort study using primary care record data from the UK Clinical Practice Research Datalink. We used multivariable logistic regression to compare antidepressant prescribing during the first five years of starting oral antidiabetic medication to a comparison group without type 2 diabetes, matched based on GP practice, age and sex. We performed subgroup analyses stratified by sex, age and ethnicity. People with type 2 diabetes and depression were 75% less likely to be prescribed an antidepressant compared to people with depression alone (odds ratio (OR) 0.25, 95% confidence interval (CI) 0.25 to 0.26). This difference was greater in males (OR 0.23, 95% CI, 0.22 to 0.24), people older than 56 years (OR 0.23, 95% CI, 0.22 to 0.24), or from a minoritised ethnic background (Asian OR 0.14, 95% CI 0.12-0.14; Black OR 0.12, 95% CI 0.09-0.14). There may be inequalities in access to antidepressant treatment for people with type 2 diabetes, particularly those who are male, older or from minoritised ethnic backgrounds.

Cardiac Rehabilitation for Fontan Circulation Patients: A Systematic Review, and Meta-Analysis

Background and Objectives: Despite advances in the surgical management of patients with Fontan circulation, their exercise capacity and quality of life remain significantly impaired. Exercise-based cardiac rehabilitation (CR) offers promising improvements in these areas, but the implementation and adherence to these programmes are often inconsistent. This systematic review and meta-analysis aimed to evaluate the safety, efficacy, and optimal exercise modalities for Fontan patients. Materials and Methods: A systematic search of PubMed, Scopus, Web of Science, and Cochrane Library was conducted on 24 August 2023. Studies were screened and assessed for quality using the Cochrane RoB Tool 2 and STROBE checklist. Meta-analysis was performed using a continuous random-effects model to determine the effectiveness of various CR interventions, including aerobic exercise training (AET), resistance training, and inspiratory muscle training (IMT). Results: A total of 26 studies (7 RCTs, 19 cohorts) comprising 22 distinct cohorts were included, with a total sample size of 428 Fontan patients. The interventions ranged from 4 weeks to 24 months and included AET (18 studies), resistance training (11 studies), and IMT (6 studies). The meta-analysis revealed significant improvements in exercise capacity, with a pooled mean difference in peak VO2 of 1.947 (95% CI: 1.491 to 2.402, p &lt; 0.001). Subgroup analyses showed that combined AET and resistance training had the most robust effect, with a mean difference of 2.11 (95% CI: 1.57 to 2.65, p &lt; 0.001). Home-based interventions showed significant benefits, while supervised and hybrid interventions did not show statistically significant differences. Publication bias was identified, particularly in home-based interventions, where smaller studies demonstrated larger effect sizes, as confirmed by Egger’s test (Intercept = 2.417, 95% CI: 1.498 to 3.337, p = 0.001). However, no significant bias was detected in supervised or hybrid interventions, which displayed symmetrical distributions in funnel plots and non-significant Egger’s test results. Conclusions: CR appears to be an effective intervention for improving exercise capacity in Fontan patients, particularly when combining AET with resistance training. Home-based programmes offer promising results, though the potential for publication bias, especially in smaller studies, warrants cautious interpretation of these findings. Further research is needed to refine protocols, explore long-term outcomes, and determine the underlying mechanisms, particularly for patients with more severe clinical presentations. The low incidence of adverse events across the studies reinforces the safety of these interventions.

Sex-related differences in early morphological and clinical outcomes in patients with type A intramural hematoma: an observational cohort study.

To investigate sex-based differences in presenting characteristics and early outcomes of type A intramural haematoma. Patients with type A intramural haematoma in an institutional cohort were consecutively enrolled between December 2013 and July 2022. Presenting characteristics, morphological progression and all-cause death during hospitalisation were evaluated according to sex. Among 473 patients, 48.0% were female. Females were older (65.9 ± 9.1 vs 58.5 ± 11.5 years, P < 0.001) with larger ascending aortic diameters (52.2 ± 6.6 vs 48.3 ± 6.1 mm, P < 0.001), thicker hematomas (11.5 ± 4.9 vs 9.5 ± 3.4 mm, P < 0.001), and more frequent focal intimal disruptions (45.4% vs 29.7%, P < 0.001). Within 30 days of initial medical therapy, 89.8% of males vs 70.1% of females showed morphological regression or stable condition on repeat CTA. The in-hospital mortality was 9.7% in females (n = 22) and 2.8% in males (n = 7). Kaplan-Meier analysis revealed higher early mortality in females (P = 0.002). Multivariable Cox regression showed female sex as an independent risk factor for early death (HR: 2.8, 95% CI: 1.2-6.8, P = 0.021). Subgroup analysis revealed no heterogeneity according to subgroups including older age (71-90 years), ascending aortic diameter ≥ 50 mm, presence of focal intimal disruption, presence of pericardial effusion, haematoma thickness ≥ 11 mm, and hypertension. Female patients with type A intramural haematoma presented with worse characteristics, higher early morphological progression, and an increased risk of early death compared to males.

Dynamic trajectories of left ventricular ejection fraction in heart failure with improved ejection fraction.

Heart failure with improved ejection fraction (HFimpEF) has been regarded as a new heart failure (HF) type in 2022. However, studies on the impact of left ventricular ejection fraction (LVEF) trajectories on the prognosis of patients with HFimpEF are scarce. In this study, we investigated dynamic trajectories of LVEF and different clinical outcomes in HFimpEF. This was a multi-center study included patients diagnosed with HF with reduced ejection fraction (HFrEF) between January 1, 2015, and October 31, 2022. Enrolled patients were divided into HFimpEF and persistent HFrEF groups. To further investigate different LVEF trajectories in HFimpEF patients, they were classified into persistent HFimpEF and transient HFimpEF subgroups. Adverse clinical outcomes encompassed all-cause death, cardiovascular death, and HF-related rehospitalization. A total of 734 patients were included (HFimpEF: n = 162; persistent HFrEF: n = 572). Cox regression analysis revealed that compared with persistent HFrEF, patients with HFimpEF experienced a lower risk of all-cause and cardiovascular death. Subgroup analysis determined that only 113 (69.75%) patients maintained an LVEF exceeding 40%. Cox regression analysis revealed that persistent HFimpEF patients had a lower risk of all-cause and cardiovascular death compared to those with transient HFimpEF. Finally, multivariate logistic analysis showed that gender and high-density lipoprotein cholesterol levels were independent predictors of persistent HFimpEF. HFimpEF does not accurately represent HF recovery, given that there are different trajectories of LVEF in HFimpEF. Patients with persistent HFimpEF experience better clinical outcomes, highlighting clinicians should identify clinical modifiable factors to maintain a stable HF stage for better prognosis. ChiCTR2400086622, 08/07/2024.

Fasting plasma glucose level and in-hospital cardiac arrest in patients with acute coronary syndrome: findings from the CCC-ACS project

Background The prognosis of patients with coronary artery disease is adversely affected by elevated fasting plasma glucose (FPG) levels. However, the relationship between FPG levels and in-hospital cardiac arrest (IHCA) remains unclear. Objectives The objective of this study was to investigate the association between FPG levels and IHCA in patients diagnosed with acute coronary syndrome (ACS). Methods Data from a total of 31,726 ACS patients fitted with inclusion and exclusion criteria across 241 hospitals in the Improving Care for Cardiovascular Disease in China-ACS project from November 2014 to July 2019 were collected. Different logistic regression models were utilized to examine the associations of FPG levels with IHCA. Sensitivity analyses were then conducted to assess the robustness of the findings. Marginal effect analyses were also employed to evaluate the impact of different therapies. Results A total of 335 cases of IHCA and 293 in-hospital mortality were recorded throughout the study. A non-linear relationship between FPG levels and IHCA was identified after adjusting for the covariates. Specifically, a significant association was found between elevated FPG levels (≥6.1 mmol/L) and an increased risk of IHCA. These findings remained consistent across different subgroup analyses including both the diabetic and non-diabetic patients. Additionally, the marginal effect analyses revealed that percutaneous coronary intervention could lower the high FPG-related risk. Conclusions The study findings showed a positive correlation between FPG levels and a higher incidence of IHCA, irrespective of the presence of diabetes.

Association between the plasma ceramide and coronary microvascular resistance

BackgroundPlasma ceramide plays a potentially significant role in the pathogenesis of coronary microvascular dysfunction. However, the relationship between plasma ceramide and coronary microvascular resistance in patients remains unclear. This study aimed to evaluate the association between plasma ceramide levels, as well as their distinct ratios, and coronary microvascular resistance.MethodsThis single-center observational study retrospectively enrolled patients who underwent both ceramide measurement and coronary angiography during hospitalization. The microvascular resistance of the coronary arteries was assessed in all patients using the angiography-derived index of microcirculatory resistance (Angio-IMR). The cumulative coronary microvascular resistance was calculated by summing the microvascular resistance of the three main coronary arteries. Multiple linear and logistic regression analyses were employed to evaluate the relationship between plasma ceramide and cumulative coronary microvascular resistance. Restricted cubic spline (RCS) analysis was conducted to investigate the association between plasma ceramide levels and cumulative coronary microvascular resistance. Receiver operating characteristic (ROC) curves were employed to evaluate the predictive value of plasma ceramide for coronary microvascular resistance. Additionally, subgroup analyses and interaction tests were performed.ResultsA total of 225 patients were included in this study, with a median cumulative coronary microvascular resistance of 48.04 (40.32–56.73). After adjusting for potential confounding factors, both plasma 16:0 ceramide and the 16:0/24:0 ceramide ratio were positively associated with cumulative coronary microvascular resistance [standardized β ± standard error: 75.05 ± 8.46 (P < 0.001) and 91.72 ± 20.41 (P < 0.001), respectively]. Similar independent associations were observed in predicting high cumulative microvascular resistance [β = 8.03 ± 1.91 (P < 0.001) and 9.98 ± 3.88 (P = 0.010), respectively]. Additionally, a significant nonlinear relationship was observed between plasma 16:0 ceramide, the 16:0/24:0 ceramide ratio, and cumulative coronary microvascular resistance (P for nonlinear < 0.05). The ROC analysis revealed that the optimal cut-off for plasma 16:0 ceramide is 0.178 µmol/L, with a specificity of 57.1% and a sensitivity of 91.2%. For the 16:0/24:0 ceramide ratio, the optimal cut-off is 0.072, yielding a specificity of 73.2% and a sensitivity of 54.9%. Subgroup analysis indicated that the association between plasma ceramide and coronary microvascular resistance was trending toward non-significance in patients with acute coronary syndrome (ACS).ConclusionsA significant nonlinear relationship exists between plasma ceramide and coronary microvascular resistance, which holds important clinical implications for the risk stratification of coronary microvascular disease. New insights into the potential effects of ceramides enhance our understanding of the complex mechanisms underlying coronary microvascular disease and warrant further investigation in a broader population.Graphical abstract

Glucose-albumin ratio (GAR) as a novel biomarker for predicting postoperative pneumonia (POP) in older adults with hip fractures

Postoperative pneumonia (POP) is a common complication after hip fracture surgery and is associated with increased mortality and other complications in elderly patients. This study aims to evaluate biomarkers, especially the glucose-albumin ratio (GAR), for predicting POP in elderly hip fracture patients. A total of 1279 elderly patients admitted to our hospital with hip fractures were included. We assessed 29 biomarkers and focused on GAR to determine its prognostic and predictive value for POP. Multivariable logistic regression and propensity score-matched analyses were conducted to calculate adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for POP, adjusting for potential confounders. Receiver operating characteristic (ROC) curves were utilized to determine the optimal cut-off of GAR for predicting POP. Among the biomarkers and combinations assessed, GAR demonstrated superior predictive capability for POP in elderly hip fracture patients. ROC analyses showed moderate predictive accuracy of GAR for POP, with an area under the curve of 0.750. Using the optimal cut-off of 0.175, the high GAR group was significantly associated with increased odds of POP (adjusted OR 2.14, 95%, CI 1.50–3.05). These associations remained significant after propensity score matching and subgroup analyses. Dose–response relationships between GAR and POP were observed. In conclusion, GAR may be a promising biomarker to predict POP risk in elderly hip fracture patients. Further studies are warranted to validate its clinical utility. However, this study has certain limitations, including its retrospective design, potential for selection bias due to the exclusion criteria, and the single-center nature of the study, which should be addressed in future prospective, multicenter studies.

Association of serum uric acid with all-cause and cardiovascular mortality in cardiovascular disease patients

The relationship between serum uric acid (SUA) and mortality in patients with cardiovascular disease (CVD) remains controversial. We aimed to explore the relationship between SUA and all-cause mortality (ACM) and cardiovascular mortality (CVM) in adult patients with CVD. This cohort study included 3977 patients with CVD from the National Health and Nutrition Examination Survey (2005–2018). Death outcomes were determined by linking National Death Index (NDI) records through December 31, 2019. We explored the association of SUA with mortality using weighted Cox proportional hazards regression models, subgroup analysis, Kaplan-Meier survival curves, weighted restricted cubic spline (RCS) models, and weighted threshold effect analysis among patients with CVD. During a median follow-up of 68 months (interquartile range, 34–110 months), 1,360 (34.2%) of the 3,977 patients with cardiovascular disease died, of which 536 (13.5%) died of cardiovascular deaths and 824 (20.7%) died of non-cardiovascular deaths. In a multivariable-adjusted model (Model 3), the risk of ACM (HR 1.38, 95% CI 1.16–1.64) and the risk of CVM (HR 1.39, 95% CI 1.04–1.86) for participants in the SUA Q4 group were significantly higher. In patients with CVD, RCS regression analysis revealed a nonlinear association (p < 0.001 for all nonlinearities) between SUA, ACM, and CVM in the overall population and in men. Subgroup analysis showed a nonlinear association between ACM and CVM with SUA in patients with CVD combined with chronic kidney disease (CKD), with thresholds of 5.49 and 5.64, respectively. Time-dependent ROC curves indicated areas under the curve of 0.61, 0.60, 0.58, and 0.55 for 1-, 3-, 5-, and 10-year survival for ACM and 0.69, 0.61, 0.59, and 0.56 for CVM, respectively. We demonstrate that SUA is an independent prognostic factor for the risk of ACM and CVM in patients with CVD, supporting a U-shaped association between SUA and mortality, with thresholds of 5.49 and 5.64, respectively. In patients with CVD combined with CKD, the association of the ACM and the CVM with SUA remains nonlinear.

Accuracy Standards of Wearable Technologies for Assessment of Soccer Kicking: Protocol for a Systematic Literature Review.

Wearable technology is widely applied in performance monitoring, an integral part of sports and exercise sciences. The kick movement in soccer exemplifies a sports technique that could benefit from appropriate biomechanics assessment methodologies. However, the accuracy of wearables in quantifying soccer kick mechanics, particularly under field conditions, remains unclear. This study aims to present a protocol for a systematic review to discuss the measurement properties (validity, reliability, and/or accuracy aspects) of wearable technology systems explicitly used to measure ball-kicking features in soccer. This review protocol was preregistered in the Open Science Framework. A total of 2 authors will perform searches in major electronic databases using specific keyword combinations in PubMed, Physical Therapy and Sports Medicine, Web of Science, ProQuest, IEEE Xplore, EBSCOHost, and Scopus. Following a specific population, intervention, comparison, outcome framework (population: soccer players and/or collected human data in a football-related environment; intervention: at least 1 wearable used; comparator: criterion measures, repeated testing sessions and/or actual values; outcome: ball kicking data), studies will be screened based on predetermined inclusion and exclusion criteria. The methodological quality of the included studies will be assessed using the "consensus-based standards for the selection of health measurement instruments" checklist (in studies concerning validity or reliability) or the "quality assessment of diagnostic accuracy studies" tool (in studies concerning accuracy). Data extraction will be conducted to determine the level of evidence according to the "best evidence synthesis method," and an evidence gap map will be constructed. The Cohen κ coefficient will be used to estimate the interevaluator agreement. This ongoing systematic review has completed database searches and is currently in the screening phase. Depending on the number and consistency of studies, results may be presented by meta-analysis or qualitative synthesis, with subgroup analyses considering factors such as gender, age, and playing level. The final results are expected by July 2024, with manuscript submission anticipated by November 2024. Our study will provide a comprehensive summary of the highest level of evidence available on the use of wearables for the assessment of soccer kick mechanics, providing practical guidance for athletes and sports sciences professionals regarding the validity and reliability aspects of using wearable technology to measure ball-kicking features in soccer. OSF registries https://osf.io/zm3j6. DERR1-10.2196/57433.

Association of oxidative balance score with hyperuricemia and gout: NHANES 2009-2018

IntroductionOxidative stress plays a crucial role in the development and progression of hyperuricemia/gout. This study aims to explore the relationship between the Oxidative Balance Score (OBS) and hyperuricemia/gout.MethodsThe study utilized complete data from adult participants in the National Health and Nutrition Examination Survey (NHANES) spanning from 2009 to 2018. OBS, composed of scores for 20 dietary and lifestyle factors, served as the exposure variable. Multivariable linear regression model was applied to evaluate the association between OBS and uric acid (UA). Multivariable logistic regression, subgroup analyses, and restricted cubic spline (RCS) regression were conducted to explore the relationship between OBS and hyperuricemia/gout.ResultsA total of 18,998 participants were included. In the fully adjusted model, compared to the lowest quartile, the highest quartiles of OBS, dietary OBS, and lifestyle OBS were negatively correlated with UA (β=-0.31 (-0.36,-0.25), β=-0.18 (-0.24,-0.12), and β=-0.64 (-0.69,-0.59), respectively) and hyperuricemia (OR=0.63 (0.55,0.71), OR=0.76 (0.67,0.86), OR=0.37 (0.33,0.42), respectively). Moreover, the highest quartiles of OBS and lifestyle OBS exhibited a negative correlation with gout (OR=0.72(0.58,0.91), OR=0.54 (0.43,0.67), respectively). Subgroup analyses revealed differences in the negative association between OBS and hyperuricemia concerning hypertension (p for interaction =0.002) and diabetes (p for interaction= 0.004), while gender-related disparities were observed in the negative association between OBS and gout (p for interaction =0.008). RCS analysis demonstrated a linear negative association between hyperuricemia and OBS (p for non-linearity &amp;gt;0.05), while gout exhibited a non-linear negative association (p for non-linearity&amp;lt;0.05).ConclusionThe study found that a higher OBS was associated with a decreased risk of developing hyperuricemia/gout, underscoring its potential in the prevention and management of these conditions.

Measuring brain perfusion by computed tomography or magnetic resonance as ancillary tests for diagnosis of brain death: a systematic review and meta-analysis

Abstract Objectives To gather and synthesise evidence regarding diagnostic accuracy of perfusion imaging by CT (CTP) or MR (MRP) for brain death (BD) diagnosis. Methods A systematic review and meta-analysis was prospectively registered with PROSPERO (CRD42022336353) and conducted in accordance with the PRISMA guidelines and independently by three reviewers. PubMed/MEDLINE®, EMBASE® and Cochrane Database were searched for relevant studies. Quality Assessment of Diagnostic Accuracy Studies-2 was used to assess studies’ quality. Meta-analysis was performed using univariate random-effects models. Results Ten studies (328 patients) were included. Perfusion imaging (most commonly CTP, n = 8 studies) demonstrated a high sensitivity of 96.1% (95% CI: 89.5–98.6) for BD, consistent in subgroup analysis at 95.5% (95% CI: 86.5–98.6). Unfortunately, it was not feasible to calculate other metrics. Additionally, evidence of publication bias was identified in our findings. Conclusions The sensitivity of CTP or MRP for BD diagnosis is very high, comparable to CTA and TCD. However, considering most studies were retrospective, and lacked control groups and unambiguous criteria for perfusion imaging in BD assessment, results should be interpreted with caution. Future studies, ideally prospective, multi-centre and with control groups are of utmost importance for validation of these methods, particularly with standardized technical parameters. Advances in Knowledge Cerebral perfusion imaging using CT or MRI demonstrates high sensitivity in diagnosing BD, on par with CTA and TCD. Recommended by the World Brain Death group, this method holds promise for further investigation in this area.

Sleep-disordered breathing in a multi-ethnic cohort of preterm adolescents and adults: assessment of neonatal and subsequent risk factors.

Determine whether preterm-born adolescents and adults have sleep-disordered breathing (SDB), as documented by abnormal overnight oximetry. This single-center cross-sectional study prospectively enrolled adolescents and adults born moderately to extremely preterm (≤32 weeks gestation or <1500 grams birth weight) or full term to complete a study visit, STOP-Bang questionnaire, and overnight oximetry. Oxygen desaturation index (ODI) was compared in preterm versus term with Poisson regression models. Subgroup analyses in preterm participants evaluated associations of neonatal risk factors with ODI. Ninety-six preterm and 44 term participants completed study procedures. Preterm participants more often reported snoring (25% vs 9%; p=0.03) and excessive fatigue (62% vs 40%; p=0.02), and had higher body mass index, leading to higher STOP-Bang scores (2±1 vs 1±1; p<0.001). Preterm participants had 40% higher ODI (incidence rate ratio (IRR): 1.40; 95% CI [1.07,1.83]; p=0.02). However, after adjusting for classic risk factors for SDB including age and STOP-Bang score in a multivariable model, history of preterm birth did not predict additive risk for SDB. Among neonatal factors, a patent ductus arteriosus was associated with a higher ODI (IRR 1.99; 95% CI [1.37,2.91]; p<0.001). Preterm-born adolescents and adults in this study have higher rates of snoring, daytime fatigue, and nocturnal desaturations compared to those term-born. However, the risk of elevated ODI is best attributed to obesity in this cohort and not the history of prematurity. Additionally, a history of a patent ductus arteriosus increased risk for SDB.

Association of dietary anthocyanidins intake with all-cause mortality and cardiovascular diseases mortality in USA adults: a prospective cohort study

Anthocyanins, as a type of polyphenolic compound, have been discovered to offer multiple health benefits to humans, including anti-aging and anti-inflammatory properties. This prospective cohort study aims to examine the relationship of dietary intake of anthocyanin with all-cause mortality and cardiovascular diseases mortality in the US. The aim of this research was to explore the possible correlation between anthocyanin consumption and the mortality rate from all causes as well as from cardiovascular disease. Based on the Public Access NHANES-linked National Death Index files up to December 31, 2019, we identified mortality status and heart disease-specific causes of death. A multivariate Cox regression analysis was employed to evaluate the effects of anthocyanin intake on mortality outcomes, generating hazard ratios and 95% confidence intervals, adjusting for various demographic characteristics, lifestyle factors, and comorbid conditions. Additionally, we utilized Kaplan-Meier survival curves, subgroup analyses. In different scenarios, dietary anthocyanin intake was assessed using restricted cubic spline models. A total of 11,959 participants completed the final cohort, averaging 47.12 years of age (SD ± 0.35). Following adjustments for multiple variables, an inverse relationship was identified between anthocyanin intake in the highest quartile and all causes mortality, yielding a hazard ratio (HR) of 0.68 (95% CI: 0.52–0.89). Similarly, elevated anthocyanin consumption was linked to a reduction in heart disease mortality, with HR of 0.61 (95% CI: 0.38–0.97). Additionally, dose–response curve revealed a consistent decrease in both all-cause and cardiovascular mortality with increasing anthocyanin intake. Further subgroup analyses revealed that elevated intake of anthocyanins was linked to decreased all-cause mortality in White individuals and males. Moreover, high anthocyanin intake was significantly correlated with reduced all-cause mortality irrespective of hypertension or hyperlipidemia status. Our research indicates that an appropriate dietary intake of anthocyanins is associated with a reduction in overall mortality rates. Furthermore, the findings reveal a substantial association between anthocyanin intake and decreased mortality from cardiovascular diseases, suggesting that anthocyanins may effectively lower the risk of cardiovascular-related deaths.