Asymptomatic Participants Research Articles

Abstract 4136900: Left-to-right ventricular volume ratio as a predictor of cardiovascular events: The Multi-Ethnic Study of Atherosclerosis (MESA)

Background: The left ventricle (LV) and right ventricle (RV) are closely connected anatomically and functionally. Therefore, relative volume alterations signify pathologic disequilibrium even when within the normal range for chamber volumes. We aimed to define the prognostic value of volumetric imbalance between the LV and RV in the general population. Methods: The study sample consisted of 4073 asymptomatic participants from the Multi-Ethnic Study of Atherosclerosis who had a cardiac MRI at baseline. The left to right ventricular volume ratio (LRVR) was defined as LV volume/RV volume at end diastole. LRVR was categorized into balanced reference category 0.8-1.3, low (RV predominance) <0.8, and high (LV predominance) >1.3. Multivariable cox regression models were used to study the association between LRVR and heart failure (HF), atrial fibrillation (AF), and death. Results: The mean age of participants was 61.3±10 years, with 52% females. Participants were followed for a median of 17.8 years for HF, 16.7 years for AF, and 17.1 years for death. During follow up, 239 (5.9%) participants developed HF, 772 (19%) developed AF, and 906 (22.2%) died. When compared with the reference balanced LRVR group, those with high LRVR had increased risk of HF (HR 2.55; 95% CI 1.7-3.8; p <0.01), AF (HR 1.57; 95% CI: 1.2-2.06; p<0.01), and death (HR 1.63; 95% CI: 1.29-2.07; p<0.01) after adjusting for demographics and traditional cardiovascular risk factors. Participants with low LRVR had increased risk of HF (HR 1.88; 95% CI 1.1-3.2; p=0.02) and death (HR 1.51; 95% CI 1.12-2.04; p<0.01) in crude models. Adjusting for risk factors maintained increased risk of HF and death, but statistical significance was lost. Low LRVR was not associated with increased risk of AF. In a subgroup of participants with both absolute RV and LV volumes within normal ranges, high LRVR was still associated with increased risk of HF, AF, and death after adjusting for risk factors. Conclusion: In healthy asymptomatic participants at baseline, LV volume exceeding RV volume by at least 30% is associated with increased risk of HF, AF, and death. This relationship is independent of cardiovascular risk factors and absolute dilatation of either ventricle.

Comorbidity Pattern and Autonomic Nervous System Dysfunction in Patients with Chronic Vulvar Discomfort

This study examines novel concepts of comorbidity in patients with chronic vulvar discomfort using data from the DATRIV (Diagnostic Accuracy of Three Rings Vulvoscopy) study, which involved 328 participants categorized into four groups: asymptomatic individuals with normal or impaired vulvar skin and patients with chronic vulvar discomfort, classified as either vulvodynia or vulvar dermatosis. Clinical data were collected through a structured questionnaire and analyzed using statistical software, including StatSoft (Dell, Austin, TX, USA), Statistica 12 (TIBCO®, Palo Alto, CA, USA), and SPSS 20 (IBM, Armonk, NY, USA). The study received approval from the Institutional Review Board of Polyclinic Harni, and all participants provided written informed consent. The findings reveal significantly higher comorbidity rates in patients with chronic vulvar discomfort compared to other groups (p = 0.0000). A substantial percentage of asymptomatic participants with both normal (63.4%) and impaired (70.7%) vulvar skin also reported comorbid conditions. Analysis of comorbidity curves revealed distinct patterns of symptom progression, with a gradual increase in frequency from asymptomatic individuals to patients with vulvodynia, followed by a decline in vulvar dermatosis cases. These patterns highlight the central role of autonomic nervous system (ANS) dysfunction, where sympathetic hyperactivity and parasympathetic depression contribute to separate comorbidity chains. These dysfunctions may act independently or concurrently, leading to various health issues. The elevated comorbidity rates and overlapping symptomatology suggest complex pathophysiology driven by ANS dysregulation. Further research on comorbidity clusters may unveil new therapeutic targets and guide the development of multifaceted treatment strategies.

Associations between less knee kinematic variability and worse patient-reported outcomes following anterior cruciate ligament reconstruction

ABSTRACT Individuals with anterior cruciate ligament reconstruction (ACLR) exhibit less knee kinematic variability while walking than uninjured controls, associated with deleterious changes in cartilage composition linked to an increased risk for early knee osteoarthritis (KOA). It is unknown whether less knee kinematic variability is also associated with worse knee-related patient-reported outcomes (PROs) consistent with KOA development. This study examined associations between kinematic variability during gait and PROs in individuals post-ACLR. Gait kinematics and the Knee Injury and Osteoarthritis Outcome Score (KOOS) were collected from 45 participants 6-months post-ACLR (67% Females; 21.45 ± 4.56 years). Overground gait biomechanics using 3D motion capture were collected, and knee kinematics were extracted for post-processing. Sample entropy (SampEn) was used to calculate knee kinematic variability. Pearson’s product-moment correlations were conducted to determine the associations between SampEn and KOOS sub-scores. Additionally, independent samples t-tests were performed to evaluate potential differences in SampEn outcomes between individuals with and without clinically relevant symptoms (defined in the introduction). Less sagittal plane kinematic variability is associated with greater pain (r = 0.37, p = 0.01) and symptoms (r = 0.32, p = 0.03). Symptomatic participants demonstrated less sagittal plane knee kinematic variability compared to asymptomatic participants (p = 0.01). The findings suggest less variable gait patterns 6-months post-ACLR may be linked to KOA-related symptoms.

Changes in lipid abundance are associated with disease progression and treatment response in chronic Trypanosoma cruzi infection

BackgroundChagas disease, caused by the parasite Trypanosoma cruzi, is a zoonosis that affects more than seven million people. Current limitations on the diagnosis of the disease hinder the prognosis of patients and the evaluation of treatment efficacy, slowing the development of new therapeutic options. The infection is known to disrupt several host metabolic pathways, providing an opportunity for the identification of biomarkers.MethodsThe metabolomic and lipidomic profiles of a cohort of symptomatic and asymptomatic patients with T. cruzi infection and a group of uninfected controls were analysed using liquid chromatography/mass spectrometry. Differences among all groups and changes before and after receiving anti-parasitic treatment across those with T. cruzi infection were explored.ResultsThree lipids were found to differentiate between symptomatic and asymptomatic participants: 10-hydroxydecanoic acid and phosphatidylethanolamines PE(18:0/20:4) and PE(18:1/20:4). Additionally, sphinganine, 4-hydroxysphinganine, hexadecasphinganine, and other sphingolipids showed post-treatment abundance similar to that in non-infected controls.ConclusionsThese molecules hold promise as potentially useful biomarkers for monitoring disease progression and treatment response in patients with chronic T. cruzi infection.Graphical

Non-steroidal anti-inflammatory drug use and inflammatory markers associated with gallbladder dysplasia: A case-control analysis within a series of patients undergoing cholecystectomy.

Inflammation has been associated with the development of gallbladder cancer (GBC). However, little is known about the associations of both, inflammation and the use of non-steroidal anti-inflammatory drugs (NSAIDs), with preneoplastic lesions. We analyzed the association of NSAIDs and gallbladder dysplasia in 82 patients with dysplasia and 1843 patients with gallstones among symptomatic patients from a high-risk population. We also analyzed associations for 33 circulating immune-related proteins in a subsample of all 68 dysplasia cases diagnosed at the time of sample selection and 136 gallstone controls. We calculated age- and sex-adjusted odds ratios (ORs) and 95% confidence intervals (95% CIs). Biliary colic was reported among most cases (97.6%) and controls (83.9%). NSAID use was inversely associated with gallbladder dysplasia (OR: 0.48, 95%CI: 0.26-0.83). Comparing the highest versus lowest category of each immune-related protein, eight proteins were inversely associated with dysplasia with sex- and age-adjusted ORs ranging from 0.30 (95%CI: 0.12-0.77) for IL-33 to 0.76 (95%CI: 0.59-0.99) for MIP-1B. Of those, GRO remained associated with dysplasia (OR: 0.64, 95%CI: 0.45-0.91) and BCA-1 was borderline associated (OR: 0.74, 95%CI: 0.54-1.01) after adjusting the logistic regression model for sex, age, and NSAIDs. In conclusion, NSAID users were less likely to have gallbladder dysplasia, suggesting that NSAIDs might be beneficial for symptomatic gallstones patients. The inverse association between immune-related markers and dysplasia requires additional research, ideally in prospective studies with asymptomatic participants, to understand the role of the inflammatory response in the natural history of GBC and to address the biological effect of NSAIDs.

Prevalence and outcomes of American Heart Association stages of heart failure in an adult brazilian population of the ELSA-Brasil study

Abstract Aims Heart failure (HF) has a major impact on public health, affecting up to 2% of adult population. HF staging is helpful in capturing pre-clinical disease and its progression to advanced stages. We aimed to determine the prevalence and mortality of HF stages in the participants of a Brazilian adult cohort. Methods The ELSA-Brasil cohort comprises 15,105 adult public servants from 6 Brazilian capitals. In the initial evaluation of the study (2008-2010), ELSA carried out interviews and clinical, laboratory, and cardiovascular ancillary tests. In this analysis, we included participants who had electrocardiogram and echocardiogram performed at baseline visit, and additional information regarding risk factors and functional capacity. The HF stages were defined based on AHA guidelines criteria as follow: Stage 0 was defined as a healthy individual with no risk factors for heart failure. Stage A (at risk for HF) included those without cardiac structural or functional abnormality but with any of the following conditions: systemic hypertension; diabetes mellitus, obesity, history of myocardial revascularization, history of rheumatic fever, and seropositivity for Chagas’ disease. Stage B (pre-HF) was defined as asymptomatic participants with history of myocardial infarction or any major abnormalities on ECG or echocardiogram. Stage C (symptomatic HF) included participants with a clinical history of HF, or HF symptoms in the presence of structural heart disease (defined as in Pre-HF stage). Considering the community-dwelling profile of the sample, we did not expect to have advanced heart failure patients in our sample. Results We included the 3,267 participants (61±9 years; 53% women) with baseline data. Prevalences of HF stages were stage 0: 938 (29%) A: 1,385 (42%), B: 651 (28%) and C: 293 (9%), with different distribution between sexes (p<0.001). Older participants had higher prevalences of stages B and C (p<0.001), with the prevalence of stage C increasing from 1.8% at 35-44 years to 12.2% at 65-74 years. After 12 years of follow-up, total mortality rates of HF stages were Stage 0: 4%; A:10%. B: 16%, and C: 26%, and respective Cox proportional hazard ratios [95% CI] adjusted for age and sex were A: 1.94 [1.3-2.8], B:2.78 [1.9-4.1], and C: 5.39 [3.6-8.1] compared to stage 0. Conclusions The prevalence of HF in Brazilians reflects what is described in international literature, with a large proportion of individuals in pre-symptomatic stages. A notable shift in the sample toward pre-symptomatic and symptomatic HF occurred gradually and persistently across the age span studied. Mortality rates increase incrementally across the HF stages. This information is important for understanding and planning health policies for this syndrome.

Morphological Changes in the Lumbar and Abdominal Muscles in Individuals with Sacralization

Although sacralization is one of the most common congenital anomalies of the spine, its effect on surrounding muscles is still not well known. This study was conducted to determine the size of the lumbar and abdominal muscles of the individuals with sacralization and to compare with the control group. Eighty-five participants with sacralization phenomena and fifty-six asymptomatic participants were included in this study. Sacralization was classified according to the Castellvi classification. The cross-sectional area of the multifidus lumborum, erector spinae and rectus abdominis muscles, and the section thicknesses of external abdominal oblique, internal abdominal oblique and transversus abdominis muscles were measured bilaterally on axial computed tomography images at the L1-2 and L4-5 levels. ANCOVA revealed that there is no any significant group*side interaction effect regarding muscles sizes in terms of two groups in L1-L2 and L4-L5. In addition, ANCOVA revealed a both side effect [(p=.020; η2p=.038)] and group*side interaction effect [(p=.010; η2p=.049)] regarding length of the L5 transverse process (p˃.05). Regardless of low back pain, muscle sizes are not associated with the sacralization phenomenon.

Hip Manipulation Increases Electromyography Amplitude and Hip Joint Performance: A Double-Blind Randomized Controlled Study

(1) Background: Activation of the gluteus medius (GM) muscle while minimizing the involvement of the tensor fascia latae (TFL) is crucial in treating many lower limb and lumbar spine injuries. Previous studies have demonstrated the effectiveness of joint manipulations in regulating muscle activity. The main objective of this study was to evaluate the effects of hip joint manipulation (HJM) on the muscle strength and activity (GM and TFL) of hip abductors in asymptomatic young participants. (2) Methods: The study followed a double-blind randomized controlled design. Thirty healthy, physically active women and men, free from spinal and lower limb injuries, voluntarily participated. The participants were allocated to two groups: those allocated to the HJM intervention and those in the control group receiving a sham intervention. They were assessed before and after the intervention using surface electromyography to measure muscle activation (EMGRMS) of the GM and TFL during maximal voluntary isometric hip abduction. (3) Results: HJM resulted in a significant increase in EMGRMS amplitude solely within the GM muscle (p < 0.01); (4) Conclusions: This study suggests that HJM may increase EMGRMS amplitude in the GM muscle; however, the effects are neither statistically nor clinically significant when compared to the control group for most of the muscles analyzed.

Relationship between the flexion relaxation phenomenon and kinematics of the multi-segmental spine in nonspecific chronic low back pain patients

The flexion relaxation phenomenon (FRP) is characterized by the reduction of paraspinal muscle activity at maximum trunk flexion. FRP is reported to be altered (persistence of spinal muscle activity) in more than half of nonspecific chronic low back pain (NSCLBP) patients. Little is known about how the multi-segmental spine affects FRP. The aim of this observational study was to investigate the relationship between FRP and kinematic parameters of the multi-segmental spine in NSCLBP patients. Forty NSCLBP patients and thirty-five asymptomatic participants performed a standing maximal trunk flexion task. Surface electromyography was recorded along the erector spinae longissimus. The kinematics of the spine were assessed using a 3D motion analysis system. The investigated spinal segments were upper thoracic, lower thoracic, thoracolumbar, upper lumbar, lower lumbar, and lumbopelvic. Upper lumbar ROM, anterior sagittal inclination of the upper lumbar relative to the lower lumbar in the upright position, and ROM of the upper lumbar relative to the lower lumbar during full trunk flexion were significantly correlated with the flexion relaxation ratio (Rho 0.42 to 0.58, p < 0.006). The relative position and movement of the upper lumbar segment seem to play an important role in the presence or absence of FRP in NSCLBP patients.

Effect of asymptomatic intervertebral flexion patterns on lumbar disc pressure: A finite element analysis study.

Movement patterns may be a factor for manipulating the lumbar load, although little information is yet available in the literature about the relationship between this variable and intervertebral disc pressure (IDP). A finite element model of the lumbar spine (49-year-old asymptomatic female) was used to simulate intervertebral movements (L2-L5) of 127 asymptomatic participants. The data from participants that at least completed a simulation of lumbar vertebral movement during the first 53% of a movement cycle (flexion phase) were used for further analyses. Then, for each vertebral angular motion curve with constant spatial peaks, different temporal patterns were simulated in two stages: (1) in lumbar pattern exchange (LPE), each vertebral angle was simulated by the corresponding vertebrae of other participants data; (2) in vertebral pattern exchange (VPE), vertebral angles were simulated by each other. The k-mean algorithm was used to cluster two groups of variables; peak and cumulative IDP, in both stages of simulations (i.e., LPE and VPE). In the second stage of the simulation (VPE), Kendall's tau was utilized to consider the relationship between different temporal patterns and IDPs for each individual lumbar level. Cluster analyses showed that the temporal movement pattern did not exhibit any effect on the peak IDP while the cumulative IDP changed significantly for some patterns. Earlier involvement in lumbar motion at any level led to higher IDP in the majority of simulations. There is therefore a possibility of manipulating lumbar IDP by changing the temporal pattern with the same ROM, in which optimal distribution of the loads among lumbar levels may be applied as preventive or treatment interventions. Evaluating load benefits, such as load, on biomechanically relevant lumbar levels, dynamically measured by quantitative fluoroscopy, may help inform interventional exercises.

Association of Resilience-Related Life Experiences on Variability on Age of Onset in Dominantly Inherited Alzheimer Disease.

It remains unknown whether the associations between protective lifestyles and sporadic dementia risk reported in observational studies also affect age at symptom onset (AAO) in autosomal dominant Alzheimer disease (ADAD) with predominant genetic influences. We investigated the associations between resilience-related life experiences and interindividual AAO variability in ADAD. We performed a longitudinal and confirmatory analysis of the Dominantly Inherited Alzheimer Network prospective observational cohort (January 2009-June 2018, follow-up duration 2.13 ± 2.22 years), involving clinical, CSF, and lifestyle/behavioral assessments. We performed a 2-pronged comprehensive resilience assessment in each cohort. Cohort 1, incorporating the general resilience definition (cognitive maintenance [Clinical Dementia Rating = 0] despite high pathology), included carriers during the periods of significant CSFp-tau181 variability and grouped into resilience/resistance outcome bins according to the dichotomous pathologic and cognitive statuses, subcategorized by the estimated years from expected symptom onset (EYO). Cohort 2, focused on ADAD-specific genetically determined time frame characterizing the onset predictability, included asymptomatic participants with available preclinical lifestyle data and AAO outcomes and grouped into delayed or earlier AAO relative to the parental AAO. Associations of cognitive, CSFp-tau181, and lifestyle/behavioral predictors with binary outcomes were investigated using logistic regression. Of 320 carriers (age 38.19 ± 10.94 years, female 56.25%), cohort 1 included 218 participants (39.00 ± 9.37 years, 57.34%) and cohort 2 included 28 participants (43.34 ± 7.40 years, 71.43%). In cohort 1, 218 carriers after -20 EYO, when the interindividual variability (SD) of CSFp-tau181 first became more than twice greater in carriers than in noncarriers, were grouped into low-risk control (asymptomatic, low pathology, n = 103), high-resilience (asymptomatic despite high pathology, n = 60), low-resilience (symptomatic despite low pathology, n = 15), and susceptible control (symptomatic, high pathology, n = 40) groups. Multivariable predictors of high resilience, controlling for age and depression, included higher conscientiousness (odds ratio 1.051 [95% CI 1.016-1.086], p = 0.004), openness to experience (1.068 [1.005-1.135], p = 0.03) (vs. susceptible controls), and agreeableness (1.082 [1.015-1.153], p = 0.02) (vs. low resilience). From 1 to 3 years before parental AAO (cohort 2), the multivariable predictor of delayed AAO, controlling for CSFp-tau181, was higher conscientiousness (0.916 [0.845-0.994], p = 0.036). Among the cognitively and socially integrated life experiences associated with resilience, measures of conscientiousness were useful indicators for evaluating resilience and predicting future dementia onset in late preclinical ADAD.

Prevalence and characteristics of 11 potentially diarrhoeagenic microbes in asymptomatic individuals in Norway, 2015-2020.

We aimed to estimate the prevalence of potentially diarrhoeagenic microbes (PDMs) in faecal samples from asymptomatic individuals in a high-income country, identify risk factors for carriage and to identify microbial factors that differ between PDMs in asymptomatic versus symptomatic individuals. Samples from 1000 asymptomatic participants were collected, together with a questionnaire, between 2015 and 2020 and examined by PCR for 11 PDMs. Isolates were characterised and potential risk factors were registered. Atypical enteropathogenic Escherichia coli (aEPEC), Yersinia enterocolitica, Shiga toxin-producing E. coli (STEC), enterotoxigenic E. coli (ETEC) and Campylobacter spp. were found in 163 (16%), 20 (2.0%), 17 (1.7%), 12 (1.2%) and 11 (1.1%) asymptomatic individuals, respectively. Other PDMs were rare. Only low virulent STEC, with stx1c, stx2b or stx2f, was detected. Travels outside Europe was a significant risk factor for detecting Campylobacter spp. (odds ratio (OR) 6.99; 95% CI 1.12-43.6) and ETEC (OR 11.4; 95% CI 1.26-102). Individuals ≥65 years of age had lower odds of carrying STEC (OR 0.11; 95% CI 0.02-0.57) or EPEC (OR 0.09; 95% CI 0.05-0.16) than individuals ≤5 years of age. The common finding of PDMs in asymptomatic individuals could have implications for the interpretation of positive findings in clinical samples and infection control measures.

Genetic and clinical correlates of two neuroanatomical AI dimensions in the Alzheimer’s disease continuum

Alzheimer’s disease (AD) is associated with heterogeneous atrophy patterns. We employed a semi-supervised representation learning technique known as Surreal-GAN, through which we identified two latent dimensional representations of brain atrophy in symptomatic mild cognitive impairment (MCI) and AD patients: the “diffuse-AD” (R1) dimension shows widespread brain atrophy, and the “MTL-AD” (R2) dimension displays focal medial temporal lobe (MTL) atrophy. Critically, only R2 was associated with widely known sporadic AD genetic risk factors (e.g., APOE ε4) in MCI and AD patients at baseline. We then independently detected the presence of the two dimensions in the early stages by deploying the trained model in the general population and two cognitively unimpaired cohorts of asymptomatic participants. In the general population, genome-wide association studies found 77 genes unrelated to APOE differentially associated with R1 and R2. Functional analyses revealed that these genes were overrepresented in differentially expressed gene sets in organs beyond the brain (R1 and R2), including the heart (R1) and the pituitary gland, muscle, and kidney (R2). These genes were enriched in biological pathways implicated in dendritic cells (R2), macrophage functions (R1), and cancer (R1 and R2). Several of them were “druggable genes” for cancer (R1), inflammation (R1), cardiovascular diseases (R1), and diseases of the nervous system (R2). The longitudinal progression showed that APOEε4, amyloid, and tau were associated with R2 at early asymptomatic stages, but this longitudinal association occurs only at late symptomatic stages in R1. Our findings deepen our understanding of the multifaceted pathogenesis of AD beyond the brain. In early asymptomatic stages, the two dimensions are associated with diverse pathological mechanisms, including cardiovascular diseases, inflammation, and hormonal dysfunction—driven by genes different from APOE—which may collectively contribute to the early pathogenesis of AD. All results are publicly available at https://labs-laboratory.com/medicine/.

Blood Flow of the Infraspinatus Muscle in Individuals With and Without Shoulder Pain and Myofascial Trigger Points: A Color Doppler Ultrasound and Reliability Study.

Myofascial trigger points (MTrPs) are potential contributors to shoulder pain and can lead to local ischemia and hypoxia, thus causing pain. Color Doppler ultrasound (US) has been used to examine the vascular environment around MTrPs, but has not been used to examine blood flow impairments in patients with shoulder pain and MTrPs. The reliability of color Doppler US for measuring infraspinatus muscle blood flow also has not been established. This study aimed to investigate differences in blood flow between individuals with and without shoulder pain and the reliability of Doppler US for measuring infraspinatus muscle blood flow. Forty participants were enrolled, 20 with shoulder pain and MTrPs and 20 without. Color Doppler US examination was performed twice on each participant to measure peak systolic velocity (PSV), end-diastolic velocity (EDV), resistive index (RI), and pulsatile index (PI) of the infraspinatus muscle. The symptomatic participants had significantly higher PSV (ie, impaired blood flow) than the asymptomatic participants. There were no significant between-group differences in EDV, RI, and PI. The results also demonstrated good-to-excellent intra-rater reliability for color Doppler US measurements of PSV, EDV, RI, and PI for both groups. This study demonstrated differences in blood flow near MTrPs in the infraspinatus muscle between individuals with and without shoulder pain. It also established good-to-excellent reliability of color Doppler US in measuring infraspinatus muscle blood flow. These findings suggest color Doppler US is a useful tool to identify vascular impairments for shoulder pain associated with MTrPs.

Influences of mechanical decompression using different forces on knee joint space, range of motion, and hamstring flexibility in asymptomatic subjects

INTRODUCTION: Knee joint decompression is one of the promising methods for the treatment of osteoarthritis. Yet, the most appropriate decompression force is not conclusive. OBJECTIVES: To compare the effect of different distraction force magnitudes on knee joint space, active range of motion (ROM), hamstring flexibility, and self-reported discomfort in asymptomatic subjects. METHODS AND MATERIALS: Twenty-five asymptomatic participants were recruited in this study. The dominant knee was distracted for 30 minutes in a 30° flexion position using three force magnitudes (10%, 20%, and 30% body weight (BW)). The traction forces were randomized with one week in between knee distractions. Joint space, range of motion (ROM), and hamstring flexibility were assessed before, immediately after, and 30 minutes after the distraction. The self-reported discomfort was assessed immediately after the distraction only. RESULTS: Medial joint space, ROM, and discomfort showed a significant difference between different force magnitudes post-distraction. The 20% and 30% BW force magnitudes significantly, but equally, increased joint space and ROM post distraction. The discomfort level was directly related to distraction force magnitude and the least comforting was the 30% BW force. Follow-up data was not significantly different than that for post-distraction. Hamstring muscle flexibility showed a significant. Yet, small increase after the 30% BW distraction force. CONCLUSION: Continued mechanical distraction of the knee joint using force magnitudes of 20% and 30% of body weight was effective in increasing medial joint space, active knee ROM, and hamstring flexibility in asymptomatic individuals. 20% force magnitude was more comfortable than the 30% percent.

Role of the screening with coronary computed tomography angiography on lipid management and risk factors control in an asymptomatic Chinese population: a community-based, parallel-group, open-label, randomized clinical trial (RESPECT2).

Lipid management based on cardiovascular risk level is the cornerstone of primary prevention of coronary artery disease (CAD), while the accuracy and adherence of traditional cardiovascular risk stratification have been questioned. Prevention strategies based on imaging screening for atherosclerotic plaques are found to be more objective and adherent in recent studies. This trial aims to investigate the role of coronary computed tomography angiography (CCTA) in guiding the primary prevention of CAD in a randomized controlled design. Approximately 3400 middle-aged asymptomatic community participants will be recruited and randomized in a 1:1 ratio to a traditional cardiovascular risk score-guided (usual care group) or CCTA-guided (CCTA group) strategy. Participants with cardiovascular disease, prior lipid-lowering therapy, CCTA contraindication, or serious diseases that affect life span will be excluded. The intervention strategy includes blood pressure, blood glucose, and lipid management and lifestyle modifications. Blood pressure and glucose targets and lifestyle modification recommendations keep the same in both strategies, while lipid management is personalized based on traditional risk level or CCTA results, respectively. The primary outcome is the proportion of participants taking lipid-lowering medication regularly at both 6 and 12months. The secondary outcomes include the proportion of participants achieving low-density lipoprotein cholesterol lowering targets at 12months, mean changes in lipid levels from baseline to 12months, barriers to adherence, adverse reactions related to CCTA examination, and cardiovascular events. The study is the first randomized clinical trial to examine the effectiveness of a CCTA-guided versus a traditional risk score-guided primary prevention strategy in an asymptomatic community-based population. ClinicalTrials.gov NCT05725096. Registered on 2 February 2023.

Repeated CT scans on 12,984 Asians to diagnose lung cancer once it is suspected.

In Taiwan, lung cancer remains the leading cause of cancer-related fatalities, resulting in substantial healthcare expenses. This research aims to evaluate both the frequency and the costs of low-dose computed tomography (LDCT) in individuals suspected of having lung cancer until their diagnosis of cancer. LDCT screening was not conducted on a population-wide scale, and asymptomatic participants had to cover the expenses for the screening personally or reimburse from other sources. If the screening results were positive or suspicious, National Health Insurance (NHI) could be utilized for subsequent follow-up examinations. This cohort study utilized the NHI Database and focused on individuals with suspected cases of lung cancer identified between 2010 and 2014.A total of 17,572 suspected new lung cancer cases were initially identified and assigned to the relevant International Classification of Diseases codes. Individuals with suspected lung cancer received a diagnosis following an average follow-up period of 2.24 (95%CI, 2.11-2.37) years, and required the use of 2.36 (95%CI, 2.20-2.51) repeated CT scans. The NHI expenditures incurred by the use of CT scans for monitoring suspected lung cancer cases were relatively modest.

Assessment of Helicobacter pylori Infection and Associated Risk Factors in Asymptomatic Patients Attending Muhoza Health Center

Background: H. pylori, is a bacterial pathogen that colonizes the gastric mucous lining and the epithelial tissue of the stomach. Helicobacter pylori strains infections can lead to several diseases such as duodenal ulcers, gastric ulcers, adenocarcinoma of the distal stomach, mucosa-associated lymphoid tissue (MALT) lymphoma, diabetes mellitus, cardiovascular disease and autoimmune diseases. The objectives of this study were to assess the prevalence of H. pylori infection and risk factors associated with H. pylori in asymptomatic participants attending Muhoza health center Methodology: A cross-sectional study was conducted from 13th September to 13th October. Stool samples from 60 eligible participants were collected in sterile containers and they were immunoserologicaly analysed. Rapid tests were used to detect H. pylori antigens. A liquid in the testing kit was mixed with a small portion of the stool. The mixture was poured to the sample hole on the rapid test which displayed results. Data regarding risk factors were collected using questionnaires and were analyzed statistically using SPSS 20. Results: The prevalence of H. pylori infection was 37%. Females were more affected than males, with 25% and 12% respectively. Age, education, source of water and household population were significantly associated with Helicobacter pylori with p-values &lt; 0.05. The study was limited since it was one health center based, hence not having large representative population. Conclusion: Education of the population about prevention of the infection, supply clean, treated water for home usage and drinking, are recommended to the local government authorities in Musanze. Screening for H. pylori infection, good adherence on antibiotics against H. pylori, hand washing, and proper household settings to reduce crowding issue are recommended. Further researches are recommended for more conclusive results. Keywords: H. pylori infection, risk factors, stomach, asymptomatic.

Reliability and concurrent validity of the bubble inclinometer for visual estimation of straight leg raise in asymptomatic individuals

IntroductionThe straight leg raise (SLR) test is commonly used to investigate neurodynamic problems or hamstring muscle length. Visual estimation can be used to identify the degrees of hip flexion during the SLR test. However, intra-tester and inter-tester reliability, as well as concurrent validity, await formal investigation.MethodsThis study was an experimental study. Two testers, a novice and an experienced physical therapist, measured hip flexion angles during the SLR test using visual estimation for two sessions and the bubble inclinometer method during the first session in 31 asymptomatic participants, in random order. Intra-tester reliability (intraclass correlation coefficient, ICC&lt;sub&gt;3,3&lt;/sub&gt;), inter-tester reliability (ICC&lt;sub&gt;2,3&lt;/sub&gt;), concurrent validity (Pearson correlation with bubble inclinometer), and measurement error was represented as standard error of measurement (SEM) and minimal detectable change (MDC), were calculated.ResultsThe concurrent validity and intra-tester reliability of visual estimation for both testers were good (ICC&lt;sub&gt;3,3&lt;/sub&gt; = 0.885 with 95% confidence interval = 0.775–0.943, &lt;i&gt;p&lt;/i&gt; &lt; 0.001) and excellent (ICC&lt;sub&gt;3,3&lt;/sub&gt; = 0.904 with 95% confidence interval = 0.810–0.952, &lt;i&gt;p&lt;/i&gt; &lt; 0.001), respectively. Inter-tester reliability of visual estimation was poor (ICC&lt;sub&gt;2,3&lt;/sub&gt; = 0.373 with 95% confidence interval = 0.027–0.639, &lt;i&gt;p&lt;/i&gt; = 0.018).ConclusionsAlthough the concurrent validity of visual estimation with the bubble inclinometer was good, and intra-tester reliability was excellent, the inter-tester reliability was poor. Therefore, caution should be exercised if more than one tester is involved in visual estimation.

Gender-specific outcomes of low-dose computed tomography screening for lung cancer detection: A retrospective study in Chinese never-smoker population.

Low-dose computed tomography (LDCT) has emerged as a pivotal tool for detecting lung cancer among ever-smokers. This study aims to evaluate the gender-specific outcomes of LDCT screening within the Chinese never-smoking population. We conducted a single-center, retrospective cohort study, which analyzed LDCT screening outcomes for 42,018 asymptomatic participants. Specifically, we focused on assessing gender-specific differences in the prevalence of pulmonary nodules, and the incidence of lung cancer diagnosis among never-smokers. Among the 42,018 eligible participants, 41.50% were females and 58.50% were males. Most participants were non-smokers (77.57%), with a significantly higher proportion of non-smokers among females than males (99.33% vs. 62.14%). Pulmonary nodules were identified in 2.66% of participants, with a higher prevalence in females (2.99%) than males (2.43%) (p < 0.001). Non-smoking females had a higher incidence of positive nodules than non-smoking males (2.98% vs. 2.38%, p < 0.001). Invasive biopsies were performed in 334 individuals with nodules, confirming lung cancer in 258 cases. The majority of these cancer cases were non-smokers (212), with non-smoking females showing a higher incidence (0.85%) compared to males (0.43%) (p < 0.001). There was no significant difference in the false-positive rates between non-smoking females (0.14%) and males (0.13%). Multivariate analysis showed that never-smoking women were more likely to undergo biopsies (OR 1.65, p = 0.0016) and had a higher, though not statistically significant, probability of lung cancer diagnosis (OR 1.84, p = 0.06). This study elucidates sex-based differences within the Chinese population, revealing a higher prevalence of pulmonary nodules and lung cancers among non-smoking females. These findings offer valuable reference for both clinical practice and future research initiatives.