Differences Research Articles

Quantitative Assessment of the Effect of Chronic Kidney Disease on Plasma P-Tau217 Concentrations.

Chronic kidney disease (CKD) is known to be associated with increased plasma phosphorylated tau217 (p-tau217) concentrations, potentially confounding the utility of plasma p-tau217 measurements as a marker of amyloid pathology in individuals with suspected Alzheimer disease (AD). In this study, we quantitatively investigate the relationship of plasma p-tau217 concentrations vs estimated glomerular filtration rate (eGFR) in individuals with CKD with and without amyloid pathology. This was a retrospective examination of data from 2 observational cohorts from either the Mayo Clinic Study of Aging or the Alzheimer's Disease Research Center cohorts. p-Tau217 was determined using the ALZpath Simoa p-tau217 immunoassay and an immunoprecipitation mass spectrometry assay that simultaneously measures p-tau217 and nonphosphorylated-tau217 (np-tau217) to determine %p-tau217 ([p-tau217/nonphosphorylated-tau217]) × 100%) (C2N Diagnostics). Amyloid positivity was defined by amyloid-PET and a centiloid of ≥25. Log-log linear regression fits were used to quantitatively predict increases in plasma p-tau217 associated with decreasing eGFR. Participants (n = 202, mean age of 78 years, 38% female) with diagnoses of cognitive unimpairment (n = 109), mild cognitive impairment (n = 71), and dementia (n = 22) were included. In all, 114 (56%) of all participants were amyloid-PET positive (A+). In addition, 86 (43%) of all participants were classified as having CKD (CKD stages 3-4). p-Tau217 concentrations were significantly higher in A- participants with an eGFR of <60 (mL/min/1.73 m2), as compared with those with eGFR >60 A- participants. For an eGFR of 45 vs 60 in the A- cohort, the calculated percentage changes were +31%, +55%, and +19%, for ALZpath p-tau217, C2N p-tau217, and C2N %p-tau217, respectively. For the A+ cohort, the corresponding calculated percentage changes were +17%, +15%, and -5%, respectively. CKD was associated with increased p-tau217 concentrations when measuring p-tau217 by ALZpath and C2N methodologies, but the effect was mitigated by the use of %p-tau217. These results indicate limitations for the utility of plasma p-tau217 measurements in individuals with significant renal impairment (eGFR <45 or CKD stage 3b or greater). Determination of eGFR should be considered to avoid inaccurate classification of the presence of AD-related pathology by plasma p-tau217 in individuals with CKD. This study provides Class II evidence that in individuals with CKD stage 3 (especially stage 3b) or higher, p-tau217 concentrations are increased, with a greater increase in amyloid-PET-negative individuals.

Impact of Crude Oil Contamination and Low-Temperature Thermal Desorption on Soil Properties and Remediation Efficacy

ABSTRACT Crude oil contamination significantly alters soil properties, posing environmental risks and challenges for sustainable development. This study investigates the potential of low-temperature thermal desorption (LTTD) at 110°C as an environmentally friendly remediation technique for crude oil-contaminated soils. Soil samples contaminated with crude oil from Nigeria’s Niger Delta were analyzed for changes in Atterberg limits, specific gravity, linear shrinkage, sodium percentage (PS), and total dissolved solids (TDS). After LTTD treatment at 110°C for 30 minutes, the soils were assessed using gas chromatography, Fourier transform infrared spectrometry, X-ray diffraction, and scanning electron microscopy to evaluate microstructural and mineralogical changes. Contamination increased plasticity, shrinkage, and dispersivity, while reducing specific gravity. LTTD successfully removed up to 96% of hydrocarbons, but also caused a 15% weight change and minor alterations in hydrocarbon functional groups. Scanning electron microscopy revealed particle agglomeration after remediation, which may help counter the increased dispersivity caused by contamination. X-ray diffraction showed no significant mineralogical changes in the remediated soils. LTTD at 110°C proves effective in reducing hydrocarbons and mitigating crude oil-induced soil degradation, contributing to sustainable environmental management.

Short-term effects of ambient air pollution on influenza incidence in Chongqing, China: a time-series analysis.

This study investigated the relationship between air pollution and influenza incidence in Chongqing from 2013 to 2022 using a generalized additive model (GAM), analyzing 199,712 cases. Subgroup analyses were conducted to investigate the impact of age, gender, season, and the COVID-19. Influenza incidence was positively associated with PM2.5, PM10, SO2, NO2 and CO, but negatively with O3. SO2 had the most effect. In single-day lag models, the largest percentage changes in influenza incidence at lag0 for each pollutant were: 2.930% for SO2, 1.552% for CO, -0.637% for O3, 0.516% for PM2.5, and 0.405% for PM10. NO2 showed the largest change at lag11 (1.376%). In multi-day lag models, changes peaked at lag011-014. Stratified analyses revealed children aged 0-14 years as particularly vulnerable during the cold season and COVID-19 period. The study demonstrates that short-term lags and cumulative effects of air pollution exposure increase influenza incidence, significant for establishing influenza response strategies.

S2AI and iliac screw prominence and removal for symptomatic prominence: a systematic review.

Sacropelvic fixation plays a crucial role in complex spinal surgeries, particularly in adult spinal deformity (ASD) and other conditions requiring lumbosacral stabilization. This systematic review and meta-analysis aims to compare the rates of symptomatic screw prominence and screw removal between S2-alar-iliac (S2AI) and iliac screws, as well as those examining each screw type independently, to provide a comprehensive understanding and guide surgical decision-making and improve patient outcomes. A systematic review following PRISMA guidelines was conducted using Medline, SPORTDiscus, Cochrane Library, and Scopus databases. Inclusion criteria encompassed studies evaluating screw prominence or removal rates for S2AI and iliac screws, individually or in comparison, involving adult patients with sacropelvic fixation. Data on demographics, comorbidities, surgical characteristics, and outcomes were extracted. Statistical analysis included relative risk difference (RR) calculations using a random effects model, with heterogeneity assessed via the I² statistic. Eighteen studies were included, comprising 1462 patients: 648 with S2AI screws and 814 with iliac screws. Symptomatic screw prominence was significantly lower for S2AI screws (1.9%, 12/648) compared to iliac screws (6.3%, 51/814), with a pooled RR difference of 0.08 (95% CI 0.04, p < 0.001). Screw removal rates due to prominence were 0% (0/12) for S2AI screws versus 27.5% (14/51) for iliac screws. Low heterogeneity was observed for both outcomes (I² = 3.32% for prominence, I² = 0.0% for removal). S2AI screws demonstrate significantly lower rates of symptomatic prominence and screw removal compared to iliac screws, supporting their clinical and economic advantages in sacropelvic fixation for ASD. Technological advancements and innovations in implant design further enhance the efficacy of S2AI screws. These findings advocate for their adoption as an effective fixation technique, reducing hardware complications and improving patient outcomes. Future studies will aim to explore factors influencing prominence risk and optimize surgical strategies in ASD treatment.

Central and peripheral nervous system activity and muscle oxygenation in athletes during repeated-sprint exercise in normoxia and normobaric hypoxia

ABSTRACT Aim To investigate central and peripheral nervous system activity and muscle oxygenation in athletes during repeated-sprint exercise in normoxia and normobaric hypoxia. Methods The effects on vastus lateralis muscle strength in a cross-over study were examined in 18 athletes (13 males, 5 females) completing 10 × 6-s cycle sprints. Immediately after and again 5 minutes post-exercise, electromyography (EMG), heart rate variability, maximal voluntary contraction (MVC), muscle oxygenation, peak power output, and arterial oxygen saturation were compared to 2 baseline sets named (“Baseline” and “Pre”). Results Post-exercise MVC was significantly lower (6.7 ± 10.0%) than Baseline, but root-mean-square amplitude during hypoxia (all-times) was significantly lower than normoxia (0.38 ± 0.19 vs 0.41 ± 0.17 mV). Comparative frequency analysis of the percentage change in pre- to post-exercise EMG area, at low 1–29 hz (type-1 fibre) and high 75–100 hz (type-2 fibre) areas, revealed a significant reduction in type-1 fibre activity relative to type-2, by 20–30% across time and by 10% in type-1 activity between conditions. Conclusion Exercise in hypoxia appeared to cause a temporary increase in central sympathetic nervous system activity and greater recruitment of type-2 muscle fibres, with accompanying reduction in type-1. Acute hypoxia may stimulate type-2 fibre conditioning.

Epidemiological trends and predictions of urinary tract infections in the global burden of disease study 2021

Urinary tract infections (UTIs) are prevalent; however, comprehensive and current epidemiological data remain scarce. This study examined the global, national, and regional burden of UTIs by sex, age, and socio-demographic index (SDI) from 1990 to 2021. The 2021 Global Burden of Disease study included age-standardised incidence rate (ASIR), age-standardised prevalence rate (ASPR), age-standardised death rate (ASDR), and age-standardised disability-adjusted life years rate (ASDAR). The estimated annual percentage change was used to depict temporal trends, whereas Pearson correlation analysis explore its correlation with the human development index (HDI), the SDI, and age-standardised rates (ASRs). An autoregressive integrated moving average model forecasted the UTI burden trends. From 1990 to 2021, the number of UTI cases increased by 66.45%, reaching 4.49 billion cases, with an ASIR of 5,531.88 per 100,000 population. The greatest incidence of UTIs was seen in women and older adult men. Tropical Latin America and low–middle SDI regions exhibited the highest ASIR, ASPR, ASDR, and ASDAR, while East Asia showed the lowest. ASDR and ASDAR decreased with higher SDI levels. ASR and HDI were weakly positively correlated with ASDR and ASDAR. ASIR, ASPR, and ASDAR are projected to increase until 2050. The global burden of UTIs is rising and is influenced by geographical location, age, sex, and economic development, crucial for guiding medical practices and forming relevant policies.

Genome data based deep learning identified new genes predicting pharmacological treatment response of attention deficit hyperactivity disorder

Although the efficacy of pharmacy in the treatment of attention deficit/hyperactivity disorder (ADHD) has been well established, the lack of predictors of treatment response poses great challenges for personalized treatment. The current study employed a comprehensive approach, combining genome-wide association analyses (GWAS) and deep learning (DL) methods, to elucidate the genetic underpinnings of pharmacological treatment response in ADHD. Based on genotype data of medication-naïve patients with ADHD who received pharmacological treatments for 12 weeks, the current study performed GWAS using the percentage changes in ADHD-RS score as phenotype. Then, DL models were constructed to predict percentage changes in symptom scores using genetic variants selected based on four different genome-wide P thresholds (E-02, E-03, E-04, E-05) as inputs. The current GWAS results identified two significant loci (rs10880574, P = 2.39E-09; rs2000900, P = 3.31E-09) which implicated two genes, TMEM117 and MYO5B, that were primarily associated with both brain- and gut-related disorders. The convolutional neural network (CNN) model, using variants with genome-wide P values less than E-02 (5516 SNPs), demonstrated the best performance with mean squared error (MSE) equals 0.012 (Accuracy = 0.83; Sensitivity = 0.90; Specificity = 0.75) in the validation dataset, 0.081 in an independent test dataset (Acc = 0.61, Sensitivity = 0.81; Specificity = 0.26). Notably, the variant that contributed most to the CNN model was NKAIN2, an ADHD-related gene, which is also associated with metabolic processes. To conclude, the integration of GWAS and DL methods revealed new genes contribute to ADHD pharmacological treatment responses, and underscored the interplay between neural systems and metabolic processes, potentially providing critical insights into precision treatment. Furthermore, our CNN model exhibited good performance in an independent dataset, encouraged future studies and implied potential clinical applications.

Improving VMAT dose calculation accuracy and planning quality via a GPU-accelerated Fourier transform dose calculation algorithm.

Inverse planning typically utilizes fast, less accurate dose calculation algorithms during the iterative optimization process, thus leading to dose calculation errors (DCEs) and suboptimal plans that often require dose normalization and/or plan re-optimization. A graphic processing unit (GPU) accelerated Fourier transform dose calculation (FTDC) was recently commissioned at our institution during the Eclipse treatment planning system (Varian Medical Systems) v18.0 upgrade. We hypothesize that FTDC could reduce DCEs and planning failure rates (PFRs) compared to its predecessor, multi-resolution dose calculation (MRDC), while improving efficiency through utilization of GPUs. Fifty lung SBRT plans were optimized with MRDC and FTDC dose calculation algorithms. Acuros XB (AXB) was then used for final dose calculations. DCEs for target and organ-at-risk (OAR) were calculated as the percent difference between AXB and dose calculated at the final optimization step. Plan quality was assessed using an in-house planning scorecard where PFRs were calculated as the percentage of plans that had a plan score less than 90% with optimal plans scored at 100%. FTDC showed excellent agreement with AXB in terms of planning target volume (PTV) coverage, as PTV D95% DCEFTDC averaged 0.8%±0.9%, compared to DCEMRDC's -2.5%±3.2%. DCEs for thoracic OARs were reduced with less variation when optimizing with FTDC as compared to MRDC. FTDC had a PFR of 10% (5 out of 50) versus MRDC's 32% (16 out of 50). The subsequent re-optimization rate resulted from a plan normalization of 3% or greater was 4% for FTDC compared to MRDC's 38%. FTDC with GPU acceleration reduced optimization time by 75% on average compared to MRDC without GPU acceleration. FTDC shows more accurate dose calculation accuracy compared to MRDC. Its use during the optimization process improved planning quality and efficiency assisted with GPUs.

Lymphocyte levels in Crohn’s disease patients in clinical remission are significantly lower than those in healthy people

Background and purposeInflammatory bowel disease (IBD) is a chronic, non-specific inflammatory bowel disease caused by multiple causes. Lymphocytes migration is involved in the pathogenesis of IBD. The purpose of this study was to evaluate whether there were differences in blood lymphocytes levels between IBD patients in clinical remission and healthy people.Patients and methodsA total of 94 Crohn’s disease (CD) and 20 ulcerative colitis (UC) patients were included in this study. Ninety-four people who underwent physical examination in our hospital were randomly selected as controls. We analyzed whether there were differences in white blood cell count, neutrophil count, neutrophil percentage, lymphocyte count, lymphocyte percentage between CD patients, UC patients, and healthy people.ResultsThere were significant differences in lymphocyte count (P < 0.001), lymphocyte percentage (P < 0.001), neutrophil count (P = 0.038), and neutrophil percentage (P < 0.001) between CD patients and normal people, but no statistically significant differences in sex (P = 0.216), age (P = 0.745), and white blood cell count (P = 0.757). UC patients had significant differences in white blood cell count (P = 0.005), lymphocyte count (P = 0.010), and neutrophil count (P = 0.023), but no difference in lymphocyte percentage (P = 0.968) and neutrophil percentage (P = 0.461).ConclusionsThe white blood cell count of CD patients was not significantly different from that of normal people, but the lymphocyte count and lymphocyte percentage were significantly different from that of healthy people. Similar results were not found in UC patients.

A comparative analysis of global and Chinese trends in the burden of kidney cancer from 1990 to 2021

Kidney cancer, a prevalent malignant tumor in the urinary system, poses a significant disease burden and remains a crucial public health concern. Utilizing GBD(Global Burden of Disease)2021 data, our study examined the standardized incidence, mortality, prevalence, and DALYs(Disability Adjusted Life Years) rate of renal cancer. We calculated the [1-MIR(Mortality to Incidence Ratio)] value to assess treatment outcomes and survival rates, employed a joinpoint regression model to determine the AAPC(Average Annual Percentage Change), and conducted comparative and longitudinal analyses between China and global trends. The SII(Slope Index of Inequality) and the CI(Concentration Index) were used to assess the DALYs inequality caused by kidney cancer, and the SDI(Socio-demographic Index) was used as the basis for the ranking. Through the joinpoint regression model, we calculated the AAPC and conducted a comprehensive analysis of the disease burden of kidney cancer, evaluating its current status and changing trends. From 1990 to 2021, the age-standardized incidence rate, age-standardized mortality rate, age-standardized prevalence rate, and age-standardized DALYs rate of kidney cancer in China were lower than those the global average. However, the growth rate in China was significantly faster than the global average. The age-standardized incidence rate and prevalence rate of kidney cancer in males showed a greater increase compared to females, both in China and globally. Additionally, the age-standardized rate of kidney cancer in males was notably higher than in females, particularly among middle-aged males. The (1-MIR) of renal cancer increased from 0.36 to 0.62 in China and from 0.49 to 0.58 globally. Overall, the treatment effect of renal cancer has shown some successful outcomes. The SII decreased from 53.47 to 50.19, and the CI decreased from 0.342 to 0.289. The health inequality level of kidney cancer was significant but alleviated. From 1990 to 2021, there was a noticeable increase in the global incidence of kidney cancer. Specifically, the standardized incidence and prevalence of kidney cancer in the Chinese population saw a more rapid rise compared to the global average. Additionally, the disease burden of kidney cancer remained significantly higher in males than in females.

Global trends and epidemiological impact of metabolic risk factors on atrial fibrillation and atrial flutter from 1990 to 2021

Atrial fibrillation (AF) and atrial flutter (AFL) are cardiac arrhythmias associated with high morbidity and mortality. This cross-sectional observational study assesses the epidemiological burden of AF/AFL concerning metabolic risk factors using the Global Burden of Disease (GBD) 2021 database. Age-standardized disability-adjusted life years rate (ASDR), mortality, and estimated annual percentage change were calculated. The Bayesian Age-Period-Cohort model was utilized to predict future trends in ASDR and age-standardized mortality rate (ASMR) for AF/AFL 2030. Between 1990 and 2021, ASDR rose from 34.22 to 34.94, whereas ASMR increased from 1.46 to 1.50 per 100,000 people. High/high–middle Socio-Demographic Index (SDI) regions showed decreasing trends in ASDR and ASMR, whereas low and middle SDI regions showed increasing trends. In 2021, the highest ASDR and ASMR were recorded in Australasia, North America, and Western Europe, with significant country-level variability. Projections indicate a declining trend in ASMR and stable ASDR through 2030. The global rise in AF/AFL attributable to metabolic risk factors necessitates comprehensive and region-specific public health strategies. Further research is warranted to develop and implement effective measures to mitigate these conditions and improve cardiovascular health outcomes worldwide.

Global, regional, and national disease burden attributable to high systolic blood pressure in youth and young adults: 2021 Global Burden of Disease Study analysis

BackgroundHigh systolic blood pressure (HSBP) can cause adverse cardiovascular events and is therefore associated with a heavy global disease burden. However, this disease burden is poorly understood in youth and young adults. We aimed to explore this population to better understand the evolving trends in HSBP-related disease burden, which is crucial for effectively controlling and mitigating harmful effects.MethodsThis systematic analysis used data from the 2021 Global Burden of Disease Study, spanning 1990–2021. Participants were aged 15–39 years from 204 countries/territories. We analysed HSBP-related disease burden by region, sex, age, and temporal trends. The primary outcomes were disability-adjusted life years (DALYs), mortality rates, and estimated annual percentage change.ResultsGlobally, the number of HSBP-related deaths among youth and young adults has increased by 36.11% (95% uncertainty interval [95% UI], 20.96–52.37%), whereas the number of DALYs has increased by 37.68% (95% UI, 22.69–53.65%); however, global mortality and DALY rates have remained relatively stable. In 2021, the mortality and DALY rates were 4.29 (95% UI, 3.29–5.28) and 263.37 (95% UI, 201.40–324.46) per 100,000 population, respectively. The overall HSBP-related burden was higher in males than in females, with increasing and decreasing trends for males and females, respectively. Regionally, significant improvements in HSBP-related burden were observed in most high-sociodemographic index (SDI) regions, including high-income Asia Pacific (deaths: percentage change, − 72.65%; DALYs: percentage change, − 69.30%) and Western Europe (deaths: percentage change, − 72.89%; DALYs: percentage change, − 67.48%). In contrast, middle-SDI regions had the highest number of deaths and DALYs in 2021, whereas low-middle-SDI regions had the highest mortality and DALY rates. Furthermore, low-SDI regions experienced the largest increase in the number of deaths and DALYs. The HSBP-related burden increased with age; in addition, the proportion of deaths or DALYs due to ischaemic heart disease and stroke increased with age, reaching > 75% for those > 25 years of age.ConclusionsThe increase in global HSBP-related burden among youth and young adults indicates that current preventative efforts are insufficient. Therefore, targeted measures are needed to counter the trends in HSBP-related diseases and reduce disparities across regions and sexes.

Reimbursement for services provided by clinical pharmacists in primary care: Description of changes over time in an academic primary care network in Ohio following the recognition of pharmacists as provider.

In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. In January 2021, Ohio pharmacists were recognized by Medicaid as providers, became eligible to obtain Medicaid provider identification numbers, and were able to begin billing for services using evaluation and management codes. The objectives of this study were to compare outcomes before (2020) and after (2021 and 2022) pharmacist provider status was implemented in a network of primary care clinics: (1) the percent change in pharmacist-provided services that were billed and reimbursed, 2) the percent change in pharmacist-provided services that were billed as "incident-to" versus with the pharmacist as provider, and (3) the percent change in reimbursement per encounter as a result of pharmacist-provided services. A retrospective review of all encounters and administrative claims (all payors) provided by pharmacists (7.9 full-time equivalents) within 7 primary care clinics affiliated with a large academic medical center was conducted. The data were compared year-to-year using descriptive statistics to determine the magnitude of change. A total of 14,416 encounters were included in the study (1,863 in 2020, 4,963 in 2021, and 7,590 in 2022). In 2020, 37.8% (705/1,863) of pharmacist encounters were billed for reimbursement. In 2021, this percentage increased to 39.1% (1,939/4,963) encounters, with a further increase in 2022 to 49.1% (3,725/7,590). Differences in the percentage of pharmacist encounters billed as incident-to versus pharmacist as provider were also evident, with 37.8% (705/1,863) of pharmacist encounters billed incident-to in 2020, as compared to 36.8% (2,796/7,590) in 2022. In this same time period, mean reimbursement for pharmacist-as-provider encounters increased by 189.5% (from $10.45 to $30.25) per encounter, and the number of pharmacist-as-provider encounters increased year over year (from 0% [0/1863] in 2020 to 1.1% [54/4,963] in 2021 and 12.3% [929/7,590] in 2022; P < 0.001). This study found an increase in the billing and reimbursement attributable to clinical pharmacists in primary care settings in Ohio after their recognition as providers.

COVID-19 Pandemic and Rates of Common Ophthalmic Procedures Among Medicare Beneficiaries.

The COVID-19 pandemic has altered health care delivery, including ophthalmic care. Understanding how the pandemic has changed the rates of commonly performed ophthalmic procedures is crucial for assessing the broader implications for patient care and resource allocation. To estimate the changes in the rates of the 10 most prevalent ophthalmic procedures among Medicare beneficiaries during the COVID-19 pandemic and to explore the geographic disparities in these shifts. This retrospective US cross-sectional study compared data from Medicare Part B National Summary Data Files for the calendar years 2019 and 2020. Participants included Medicare beneficiaries undergoing the 10 most common ophthalmic procedures. Data included a total of 3 879 533 procedure entries in 2019 and 3 181 439 entries in 2020. Data were analyzed from January 1, 2019, to December 31, 2020. COVID-19 pandemic. The primary outcome was the percentage change in the number of beneficiaries for each of the 10 most common ophthalmic procedures in each state. There was an overall decrease of -17.9% in the rates of the 10 ophthalmic procedures from 2019 to 2020 (99% CI, -24.8% to -11.3%). The largest reduction was observed in laser peripheral iridotomy (-43.6%; 99% CI, -51.7% to -31.9%), while eye drug injections saw the smallest decrease (-1.5%; 99% CI, -3.3% to 0.3%). Cataract surgery also saw a reduction of -23.0% (99% CI, -28.8% to -18.7%). Regionally, the Northeast experienced the greatest reductions in cataract surgery (-27.9%; 99% CI, -32.8% to -22.3%). These results show that the COVID-19 pandemic caused a notable drop in the number of common ophthalmic procedures among Medicare beneficiaries, especially in laser peripheral iridotomy, while eye drug injections saw minimal changes. The Northeast experienced the largest reductions, highlighting the pandemic's association with changes in eye care and indicating a need for focused recovery efforts in the hardest hit areas.

Efficacy and outcomes of inclisiran in the management of homozygous and heterozygous familial hypercholesterolemia: a systematic review and meta-analysis

Objective: To find out the efficacy of Inclisiran sodium in heterozygous familial hypercholesterolemia (HeFH) and homozygous familial hypercholesterolemia (HoFH) patient groups. Methods: PubMed, Embase, and Clinicaltrials.gov databases were searched for the relevant studies. Atherosclerotic parameters considered included LDL-C, total cholesterol, PCSK9, apolipoprotein-B, and non-HDL-C. Primary outcomes were the percentage difference in atherosclerotic parameters at follow-up relative to baseline values. Our study examined these primary outcomes to determine whether there is a statistically significant difference between the HeFH and HoFH groups. The risk of bias was assessed by the Cochrane risk of bias tool. Results: Analysis of four ORION clinical trials unveiled the significant difference in pooled mean differences in LDL-C (HeFH: –48.62%, HoFH: –9.12%; P &lt; 0.05) total cholesterol (HeFH: –30.31%, HoFH: –11.50%; P &lt; 0.05), apolipoprotein-B (HeFH: –39.97%, HoFH: –14.68%, P &lt; 0.05), and non-HDL-C (HeFH: –44.51%, HoFH: –12.22%; P &lt;0.05) between HeFH and HoFH groups. However, the difference in the pooled mean difference in PCSK9 values (HeFH: –68.41%, HoFH: –56.25%; P = 0.2) between the HeFH and HoFH groups was statistically insignificant. Studies were of high quality. Conclusion: There was a significant difference in the reductions in atherosclerotic lipid parameters in heterozygous and homozygous populations after the administration of inclisiran except for the PCSK9 parameter. Further studies are needed to support this conclusion.

Interchangeability of the Polar Team Pro system in determining match load and intensities in semi-professional rugby union players

ABSTRACT This study assessed the interchangeability of the 10-Hz Polar and Catapult GPS during competitive matches. The agreement between data from both GPS units worn simultaneously and processed with the manufacturer’s individual GPS-filtered software was also assessed. Thirty players competing in the Currie Cup first division competition were monitored using two different tracking systems across six matches. To determine the interchangeability between systems, player movement variables including total distance (TD), low-speed running (LSR, 0.0–14.4 km/h), high-speed running (HSR, 14.4–18.9 km/h), very high-speed running (VHSR, >18.9 km/h), acceleration efforts > 2.5 m/s2 (ACC), deceleration efforts <-2.5 m/s2 (DEC) and maximum velocity reached during each half were compared. The two systems showed good to excellent agreement (CCC = 0.83–0.98) during all selected variables. During the entire match, Polar had, on average, higher values than Catapult, except for LSR and HSR. The percentage differences between systems were 3.6% TD, 1.9% maximum velocity, −4.7% LSR, −4.6% HSR, 16.5% VHSR, 13.7% ACC and 11.9% DEC. In addition, Bland-Altman plots showed a low average difference for TD (129.1; 90.1 m), maximum velocity (0.5; 0.5 km/h), LSR (138.2; 80.9 m), HSR (21.3; 5.4 m), VHSR (35.7; 22.3 m), ACC (1.6; 1.8 efforts) and DEC (2.0; 1.2 efforts).

On the reduction of imaging time-points for dosimetry in radionuclide therapy

BackgroundThe aim was to develop a theoretical framework for how errors in estimated activities propagate to a dispersion in time-integrated activity in radionuclide-therapy dosimetry and how this affects the comparison of radionuclide-therapy dosimetry schemes.MethodsFormulae for the variance of relative errors of estimated time-integrated activities and relative differences in time-integrated activities between measurement schemes when one or more time-points are removed were derived using the law of propagation of uncertainty for a population of time-activity-curve parameters. The formulae were derived under the assumptions of fixed coefficients of variation for estimated activities, and underlying mono-exponential curves. Analytical predictions were compared with results from numerical simulations and data for kidneys, liver, and spleen from a data-set of 18 patients treated with 177Lu-DOTA-TATE.ResultsThe dispersion in time-integrated activity is minimized if the time-points used for curve fitting have a large dispersion and are centered over the mean of τ=λeff-1 over the population, where λeff is the effective decay constant (i.e., the sum of the biological and physical decay constants). For large dispersions of decay constants in the population, the centering of time-points becomes gradually less important. The analytical expressions replicated the main trends from the numerical simulations. Furthermore, the analytical expressions predicted correctly the optimal reduced imaging schedule in 9 of 12 pairwise comparisons between schedules for patients.ConclusionsThe dispersion of errors and deviations in estimated time-activity curves can be predicted using simple formulae. These formulae have the potential to be used for optimization of dosimetry measurement schemes for established and new radiopharmaceuticals as long as the mean and dispersion of biological half-lives are known in the patient population.

Ulnar variance detection from radiographic images using deep learning

Ulnar variance is a relative length difference in the wrist between the ulna and radius bones. It is a critical factor in helping to diagnose wrist disorders. The typical standard classification of length difference (ulnar variance) is divided into three major types: positive ulnar variance, negative ulnar variance, and neutral ulnar variance. Conventional or manual methods of measuring ulnar variance are long and time-consuming. With the urgent need for high efficiency and high speed, achieving more accurate diagnoses has become essential. In this paper, a deep learning-based methodology is used to automatically detect ulnar variance from radiographic images. Advanced Convolutional Neural Networks are exploited instead of traditional manual methods. Specifically, U-Net is used in the segmentation of ulna and radius bones, while DenseNets are applied to classify the type of ulnar variance. The essential contribution of this work is collecting a dataset of fully annotated wrist radiographs that are specific to this topic, which can be used as a resource to train and validate our models. Another contribution of this paper is optimizing the DenseNets model's hyperparameters to enhance its performance. Our model achieved a segmentation accuracy of 97.7% and an ulna variance classification accuracy of 92.1%. It outperformed previous deep learning-based methods in automatically segmenting the ulna and radius. This advancement not only reduces diagnosis time but also improves result reliability.

The changing burden of gout in adults aged 70 and above based on the global burden of disease 2019

IntroductionGout is a significant global health issue, particularly among adults aged 70 and above. Understanding its epidemiological evolution and associated factors is crucial for guiding interventions and improving management.MethodsThis study analyzed data from the Global Burden of Disease study to assess the prevalence and trends of gout among adults aged 70 and above from 1990 to 2019. We evaluated temporal trends and regional disparities by calculating the estimated annual percentage change (EAPCs).ResultsGlobally, the number of older adults individuals affected by gout increased from 5,316,210 cases in 1990 to 15,666,063 cases in 2019. It is noteworthy that the global burden of gout among the older adults continued to rise from 1990 to 2019, with an EAPC of 1.17 (95% CI: 1.02 to 1.32). In 2019, the prevalence rates among individuals aged 70–74, 75–79, 80–84, and 85 and above were 3,121.31 per 100,000, 3,437.17 per 100,000, 3,592.38 per 100,000, and 3,726.91 per 100,000, respectively. The regions with the highest prevalence rates of gout in 2019 were Australasia, High-income North America, and Southern Latin America, with rates of 8,500.73, 8,351.33, and 4,666.87 per 100,000, respectively. At the national level, some developed countries such as New Zealand, the United States of America, and Australia had the highest prevalence rates, reaching 8,893.74, 8,508.06, and 8,427.94 per 100,000, respectively. It is noteworthy that regions with higher levels of Socio-Demographic Index tended to have relatively higher burden of gout among the older adults, and the prevalence rates varied across different regions and age groups.ConclusionThe study underscores the persistent burden of gout among the older adults, emphasizing the need for targeted interventions to address this issue and improve public health outcomes in this demographic.

Susceptibility changes on preoperative acetazolamideloaded 7T MR quantitative susceptibility mapping predict post-carotid endarterectomy cerebral hyperperfusion.

Post-carotid endarterectomy (CEA) cerebral hyperperfusion (CH) can cause intracerebral hemorrhage and cognitive decline. Alterations in susceptibility in response to acetazolamide (ACZ) on 7T MRI quantitative susceptibility mapping (QSM) detects elevated CBV occurring due to impaired cerebrovascular autoregulation. We explored preoperative relative susceptibility changes on 7T MRI QSM in response to ACZ and their ability to predict CH following CEA. Sixty-three patients with uni-or bilateral cervical ICA stenosis ≥70% underwent 7T MRI at baseline and at 5, 10, 15, and 20 min after ACZ administration before surgery. The difference between the susceptibility of venous structures and surrounding brain parenchyma at each time point after ACZ administration relative to the difference at baseline (relative susceptibility difference; RSD) on QSM images was calculated in the cerebral hemisphere ipsilateral to surgery. Brain perfusion SPECT was conducted preoperatively and immediately following CEA to detect postoperative CH (≥ 100% rise in CBF postoperatively). In nine patients with postoperative CH, RSD was significantly increased at 5 or 10 min following ACZ administration (p < 0.05) but reduced at 15 and 20 min (p < 0.05). In 54 patients without postoperative CH, RSD at all four time points after ACZ administration was significantly lower than the baseline value (p < 0.05). The area under the receiver operating characteristic curve to predict postoperative CH was significantly greater in RSD5 (0.981; 95% CI, 0.910-0.999) than in RSD15 (0.872; 95% CI, 0.764-0.943) (p < 0.05) or RSD20 (0.780; 95% CI, 0.658-0.874) (p < 0.01). Sensitivity, specificity, and positive and negative predictive values for RSD5 at a cutoff near the left upper corner of the curve were 100%, 89%, 60%, and 100%, respectively. Logistic regression analysis revealed that only RSD5 significantly predicted postoperative CH (95% CI, 455.9-4043.6; p < 0.05). Changes in susceptibility on preoperative 7T MRI QSM following ACZ administration predict CH following CEA. Patients with increased RSD5 on pre-CEA 7T MRI QSM following ACZ administration should undergo brain perfusion imaging immediately after surgery. Detection of CH on postoperative brain perfusion imaging warrants intensive blood pressure control. CEA= carotid endarterectomy; CH= cerebral hyperperfusion; OEF= oxygen extraction fraction; ACZ= acetazolamide; QSM =quantitative susceptibility mapping; 3D =three-dimensional; RSD=relative susceptibility difference; SD= standard deviation; ROC =receiver operating characteristic.