Cohort Analysis Research Articles

Cause and Effect of Revisions in Adult Spinal Deformity Surgery: A Multicenter Study on Outcomes Based on Etiology.

While the treatment of adult spinal deformity (ASD) has increasingly favored surgical correction, the incidence of revision surgery remains high. Yet, little has been explored on the association between the etiology of reoperation and patient outcomes. To assess the impact of the etiology of revision surgery on postoperative outcomes. Retrospective cohort analysis. 891 ASD patients. Complications, radiographic parameters, disability metrics. Operative ASD patients with at least 1 revision stratified by etiology (mechanical [Mech] -pseudoarthrosis, thoracic decompensation without junctional failure, x-ray malalignment, implant failure, implant malposition, PJK ± major malalignment; infection [Infx]-early vs late onset, major vs minor; wound [Wound]; SI pain [SI Pain]). Excluded multiple etiologies, and intraoperative or medical complications. Data from the immediate visit prior to the final revision was used as baseline (rBL). Follow-up based on visits best aligned to time points after final revision. Radiographic parameters SVA, PI-LL, and PT were used to assess alignment post-revision via ANOVA. Multivariate analysis controlling for relevant covariates assessed outcome differences after final revision surgery. 891 MET INCLUSION (AGE: 60.40±14.17, 77% F, BMI: 27.97±5.87 KG/M2, CCI: : 1.80±1.73). Etiology groups were as follows: Mech: 432; Infx: 296; Wound: 65; SI Pain: 98. Surgically, Infx had lower rates of osteotomy, interbody fusion, and decompression (p<.05). Infx and SI Pain demonstrated similar correction in radiographics SVA, PI-LL, and PT (p>.05), whereas Mech had significantly less improvement by 2 years (p<.003) that improved by 5 years. Compared to without revision, the odds of MCID in ODI were 48.6% lower across groups (OR: 0.514 [.280, .945], p=.032). Indications of x-ray malalignment were 93.0% less likely to reach MCID (OR: 0.071, [.006, .866], p=.038). Similarly, implant failure negatively impacted rates of MCID (40% vs. 15.2%, p=.029). Those with PJK had 57% lower odds of MCID (33% vs 54%, OR: .43, [0.2, 0.9] p= 0.023), further negated by major malalignment (OR: 0.05, [.07, .97], p=.02). Indications of pseudarthrosis, thoracic decompensation, implant malposition were not significant. Major sepsis had lower rates of MCID compared to minor (6.4% vs. 21.2%), and early onset infection improved compared to late (OR: 1.43, [1.17, 2.98], p<.001). In the early follow-up period, the Mech group has significantly worse SRS Pain and Mental Health scores compared to other groups (1-year: Mech 1.56 vs Infx 0.83 vs SI Pain 0.72, p<0.001; 2-year: 1.88 vs 0.71 vs 0.76, p=0.034). Complication rates increased with the number of revisions and with mechanical indication (all p<.05). At 5 years, patient satisfaction was significantly more likely to improve compared to early follow-up (OR: 1.22, p=.011), along with improved pain score, in Mech group (0.89 vs 0.49 vs 0.56, p=.081). This study focused on the impact of revision as it varies with etiology and time of occurrence postoperatively. Compared to other etiologies, revision surgery due to mechanical complications had less radiographic improvement and worsening patient-reported scores in the early postoperative period despite stabilization at 5 years. The depth of impact of mechanical complication, particularly with the addition of malalignment, merits greater focus during surgical planning. III.

Clinical Outcomes of Patients With Newly Diagnosed Acute Myeloid Leukemia Receiving Treatment in a Safety-Net Hospital System.

'Standard of care' therapies for adult acute myeloid leukemia (AML) have yielded 5-year overall survival (OS) rates of 30%-45 %. Risk stratification and novel targeted therapies have improved 5-year OS rates to >75 % for certain groups in specialized centers. This is a retrospective cohort analysis of outcomes in patients ≥18 years with newly diagnosed AML treated between 2005 and 2019 in the Harris Health County, Safety-Net Hospital System in Houston, TX. 192 patients were identified. Median age was 52 years, 52 % were male and 57 % identified as Hispanic. Most patients were uninsured or indigent, receiving care under the county's financial assistance programs (62 %). Of the 184 response-assessable patients, 139 achieved composite complete remission (CRc) (76 %). 182 patients had indications for HCT and only 25 patients received HCT (14 %), with main reasons including noncitizenship status and financial/insurance constraints. The 5-year OS rate in the entire cohort was 30 % (35 % in patients <60 years and 16 % if ≥60 years), with 92 % of deaths attributed to AML-related complications. Early death (<4 weeks) rate was 2 %. Secondary, adverse-risk AML, and uninsured status all portended significantly worse OS rates, per multivariate analysis. Patients with indications for HCT who received this modality fared significantly better than those who did not receive it (5-year OS 54 % vs. 21 %). Optimizing AML remission induction regimens, reducing medication costs, ensuring timely administration of AML directed therapies, enhancing equity and diversity in clinical trials, and addressing socioeconomic factors may improve leukemia care for underserved patients.

Opioid prescribing patterns and the effect of chronic kidney disease in pediatric urology population: A retrospective cohort analysis.

Significant efforts have been undertaken to decrease opioid prescribing, but there is little research into patient-specific factors presenting as barriers in the pediatric surgical population. Non-steroidal anti-inflammatory drugs (NSAIDs) have been shown to be a safe and effective alternative to opioids for pain control, however, concerns about their impact on renal function limit their use in patients with chronic kidney disease (CKD). Data is limited on the interplay of CKD on opioid prescribing. We hypothesized that opioid reduction efforts were successful, but patients with CKD would be more likely to receive an opioid prescription than those without CKD. A retrospective cohort study of patients ≤18 years old undergoing urologic surgery from 2014 to 2022 was performed. Patients were stratified by CKD diagnosis, determined by chart diagnosis and confirmed with CKiD U25 eGFR calculations, excluding those with normal eGFR or Stage 1 CKD. Patients without a documented CKD diagnosis and without preoperative renal function testing were presumed not to have CKD. Patients were propensity matched using the optimal full algorithm across 12 different variables. Outcomes of interest were discharge opioid prescriptions, non-opioid analgesic prescriptions, and unscheduled healthcare encounters (urology clinic visits within 5 days, emergency department visits, readmissions, or reoperations within 30 days). 10,604 patients were included. 603 patients (5.7%) had a pre-existing CKD diagnosis; the majority were CKD stage 2 (77.8%, 466 patients). A significant decrease in discharge opioid prescriptions was seen for patients with and without CKD. Patients with CKD had greater opioid exposure prior to surgery (17.2%, 104 versus 2.8%, 280, p=0.04). Those with CKD were equally likely to be prescribed NSAIDs (p=0.36) and opioids (p=0.09) at discharge. Patients with CKD were more likely to present to the emergency department (ED) within 30 days of surgery (17.6% versus 7.9%, p=0.007). Similar proportions of patients with and without CKD received an opioid prescription at discharge. Patients with CKD were more likely to be exposed to opioids in-hospital earlier than non-CKD counterparts. Multiple interventions and a dedicated postoperative opioid reduction protocol worked well, even in patients with CKD where there is concern about safely receiving NSAIDs. All-cause unplanned healthcare encounters did not differ significantly within groups with introduction of these interventions.

Biceps Tenodesis in the Setting of Total Shoulder Arthroplasty: A Matched Cohort Analysis

Biceps Tenodesis in the Setting of Total Shoulder Arthroplasty: A Matched Cohort Analysis

Dynamics of Myopia Progression in Ghana-Evidence From Clinical Practice: A Retrospective Cohort Study.

To investigate the pattern of progression of myopia among a Ghanaian clinical cohort. A retrospective cohort analysis of a clinical data set of all healthy myopic participants attending a tertiary eye care center was performed. Participants' biennial refraction examinations were tracked for refractive changes 4 years after the date of the first visit. This covered the period from January 2015 to December 2019. Myopia progression was defined as a difference in spherical equivalent between consecutive biennial visits equal to, or greater than -0.50 D of myopia. The medical records of 169 myopic participants were reviewed, with the majority (53.8%) being female. Most of the participants (51.4%) were younger than 36 years, and at the end of the study period, 96 participants (56.8%), who made up the majority, showed progression of myopia Univariate regression revealed that the 36-59-year-old age range is associated with a 60% [cOR = 0.40, 95% CI: -0.17, 0.97; p = 0.04] reduced likelihood compared to those belonging to the 0-17-year-old age group, and the Mole-Dagbon ethnicity is associated with an almost fourfold [cOR = 3.80; 95% CI: -1.40, 10.316; p = 0.01] increased likelihood of experiencing myopia progression compared to those of Ga-Adangbe ethnicity. Multivariate regression revealed that the Mole-Dagbon ethnicity is associated with an increased likelihood of experiencing myopia progression 4 years after their initial visit [aOR = 3.49; 95% CI: -1.27, 9.63; p = 0.02] compared to those of Ga-Adangbe ethnicity. Our study provides important insights into myopia progression in Ghana, with findings that are consistent with global trends. The association of myopia progression with age, place of residence, degree of myopia, and ethnicity highlights the need for tailored interventions to manage this growing public health concern in African populations.

Tumescent-assisted dissection in breast surgery: Retrospective cohort analysis

Tumescent-assisted dissection in breast surgery: Retrospective cohort analysis

Evaluating the diagnostic accuracy of fetal scalp blood sampling: A retrospective cohort study.

Fetal scalp blood sampling (FSBS) can be used as an adjunctive test, in the presence of a pathological intrapartum fetal heart rate trace, to provide evidence of fetal acidaemia. The role of FSBS remains controversial, this study evaluates the diagnostic accuracy of FSBS at determining various adverse neonatal outcomes. A retrospective cohort analysis of FSBS undertaken<1h from birth in a single UK centre in 2016 and 2017. An FSBS pH of<7.20 was abnormal. Adverse outcomes were: low umbilical cord artery (UCA) pH (<7.20), neonatal acidaemia (UCA pH<7.05), and 5-minute Apgar score<7. Regression was performed to adjust for potential confounding variables. Receiver operator characteristic (ROC) curves were calculated and test accuracy, including sensitivity and specificity were determined, for an abnormal FSBS pH and adverse neonatal outcomes. Data from 407 births occurring≤60min from FSBS were analysed. To predict neonatal acidaemia, FSBS had an area under the ROC (AUROC) of 0.77 (95% CI 0.65, 0.88). To predict low Apgar scores, FSBS had an AUROC of 0.80 (95% CI 0.70, 0.90). In general, an FSBS pH of<7.20 has low sensitivity and high specificity for neonatal acidaemia (28.6% and 85.5% respectively) and for low Apgar scores (38.1%, 90.82%). As FSBS has high specificity for adverse neonatal outcomes, it could be used to exclude asphyxia as it has a high NPV. Further research is required to evaluate whether other means of FSBS assessment, e.g. lactate, have better diagnostic test accuracy.

EPH204 Health Disparities in Postpartum Complications by Race and Ethnicity: A Marketscan by Merative Retrospective Cohort Analysis

EPH204 Health Disparities in Postpartum Complications by Race and Ethnicity: A Marketscan by Merative Retrospective Cohort Analysis

Racial and ethnic disparities in patients with severe tricuspid regurgitation: The Bronx-Valve registry.

Severe tricuspid regurgitation (TR) is an adverse prognostic factor. The presence of potential racial/ethnic disparities in patient characteristics and outcomes remain unexplored. This study aimed to investigate the impact of race/ethnicity on the clinical course of severe TR. We conducted a retrospective cohort analysis of all adults diagnosed with severe TR between January 2017 and December 2019 at a quaternary-care health system. Clinical and echocardiographic features were evaluated according to race/ethnicity. TR was categorized into four etiologies: primary, cardiac implantable electronic device-induced, ventricular secondary (V-STR), and atrial secondary TR. V-STR subgroups included left-sided cardiac disease and pulmonary hypertension. The primary endpoint was 5-year all-cause mortality, with secondary endpoints being heart failure hospitalization (HFH) and cardiovascular (CV) mortality. A total of 989 patients were analyzed: 47.8%, 35.1%, and 17.1% were non-Hispanic Black, Hispanic, and non-Hispanic White, respectively, over a median follow-up of 14.8 (3-42.4) months. The mean age was 71.4±15.6years (60.9% women) with non-Hispanic Black and Hispanic patients younger yet displaying higher comorbidity burden, worse functional class, and more pronounced right ventricular remodeling. Left-sided cardiac disease was the predominant etiology (65.9%), with a higher prevalence among non-White individuals. All-cause mortality and CV mortality occurred in 575 (58.1%) and 196 (19.8%) of patients with no significant differences among groups. HFH presented in 334 (33.1%) of patients with Black patients having an increased risk compared to White individuals (HR, 1.45; 95%CI, 1.04-2.02). At the time of severe TR detection, Black and Hispanic patients, despite being younger, had higher comorbidities and more advanced disease than White patients. While 5-year mortality rates showed no significant racial/ethnic differences, Black patients had a higher risk of HFH.

Body mass index trends over four years in persons with multiple sclerosis.

The role of obesity in persons with multiple sclerosis (PwMS) is incompletely understood. Obesity predisposes individuals to a pro-inflammatory state and cardiovascular comorbidities, both of which can negatively impact MS disease course. A better understanding of weight trends in PwMS will inform optimal management of those who are overweight or obese. To determine body mass index (BMI) trends in newly diagnosed PwMS and individual characteristics associated with weight gain after diagnosis. Also, to determine the impact of physical disability on BMI changes in PwMS. We conducted two longitudinal retrospective cohort analyses using the Multiple Sclerosis Partners Advancing Technology Health Solutions (MS PATHS) database. The first characterized BMI trends in newly diagnosed PwMS. Multivariable linear regression was used to determine characteristics associated with baseline BMI. Multivariable logistic regression was used to determine characteristics associated with annualized BMI changes of ≥ 0.5 kg/m2/year and ≥ 2.0 kg/m2/year in PwMS who were overweight or obese at baseline. The second analysis evaluated BMI trends in individuals with more longstanding MS to determine the impact of disability on weight changes. Multivariable logistic regression was used with consolidated Patient Determined Disease Steps (PDDS) categories as a disability measure. There were 942 PwMS in the newly diagnosed cohort, of whom 265 (27.9 %) were overweight and 403 (42.4 %) were obese. The average follow-up time was 2.1 years, and the average annualized BMI change was 0.19 kg/m2/year (SD=1.5). Greater education was associated with lower baseline BMI (β=-0.31, p = 0.003) but no other characteristics were significantly associated. Greater education was also associated with lower odds of rapid weight gain at ≥ 2.0 kg/m2/year (OR=0.88, p = 0.001), while female sex was associated with higher odds of rapid weight gain (OR=1.84, p = 0.047) at the same threshold. The disability analysis included 10,394 PwMS, of whom 5,699 (54.8 %) had low disability (PDDS 0-1), 3,221 (31.0 %) had moderate disability (PDDS 2-4), and 1,474 (14.2 %) had high disability. The average annualized BMI change was 0.08 kg/m2/year for all subjects (SD=1.7), 0.10 kg/m2/year (SD=1.6) for those with low baseline disability, 0.06 kg/m2/year (SD=1.9) for those with moderate baseline disability, and 0.04 kg/m2/year (SD=1.9) for those with high baseline disability. Relative to those with low disability, moderate disability (β=1.09, p < 0.001) and severe disability (β=1.274, p < 0.001) were both associated with higher baseline BMI. Greater disability was not associated with odds of meeting thresholds for annualized BMI increases. However, women had 22 % higher odds of a ≥ 0.5 kg/m2/year increase (p = 0.002) and 31.6 % higher odds of a ≥ 2.0 kg/m2/year increase (p = 0.01). Being overweight or obese is common at MS diagnosis. Women with MS are especially susceptible to rapid weight gain, both at diagnosis and later in the disease course. Greater education is protective against rapid weight gain in newly diagnosed MS patients. Baseline disability did not have a significant relationship with annualized BMI change, but the relationship appears to vary according to the patient's age. The frequency of overweight and obese PwMS suggests that weight management is an important part of MS care.

HoLEP Safety and Efficacy in Octogenarians: A Retrospective ACS-NSQIP Analysis (2011-2020)

ObjectiveTo evaluate the safety of Holmium laser enucleation of the prostate (HoLEP) in octogenarian compared to non-octogenarian patients. MethodsA retrospective cohort analysis was performed using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database from 2011 to 2020. We assessed baseline demographic data, American Society of Anesthesiologists (ASA) score, functional status, and medical comorbidities. Our primary outcome was the incidence of postoperative complications, the need for re-operation, and re-admission within 30 days following the procedure between octogenarians and non-octogenarians. A multivariate logistic model was utilized to identify predictors for postoperative complications. ResultsA total of 5305 patients were included. Octogenarians had higher rates of hypertension (69.9% vs. 55.5%, p < 0.001), and bleeding disorders (5.1% vs. 2.6%, p < 0.001). The absolute risk for postoperative complications was low in the two groups. However, the octogenarians had higher rates for readmitted (6.1% vs 3.6% p = 0.006) and to receive perioperative blood transfusion (3.3% vs 0.9% p-value <0.001). Multivariable regression analysis showed a significantly lower odds ratio to develop complications in non-octogenarians (OR: 0.698) [95% CI: 0.537, 0.908, (p=0.007)]. ConclusionThere was a significant association between octogenarians and the risk of post-operative complications of HoLEP however the absolute risk remained low. We believe that operative outcomes for octogenarians can be optimized with careful selection given the low incidence of complications.

Established and novel insights to guide cancer assessment in patients with idiopathic inflammatory myopathies.

Older age, dermatomyositis, and specific serum autoantibodies such as anti-TIF1-γ are associated with higher cancer risk in patients with myositis. We evaluated a vast cohort of patients with myositis for the prevalence of cancer, the association to disease features, and the performance of the recent IMACS guidelines. A retrospective cohort analysis was performed and in all cases serum autoantibodies were tested using HEp-2, immunoassays, RNA- and protein-immunoprecipitation. Myositis was defined as cancer-associated if malignancy occurred within 3 years prior to or after the onset of myositis. Ninety-five patients with IIM were followed-up for a median of 6 years (interquartile range 3-11), the majority were classified as 'high-risk' or 'intermediate-risk' of cancer based on IMACS guidelines. A diagnosis of cancer was made in 22/95 (23 %) of cases and, based on the timing of the diagnosis, 14 % patients were cancer-associated myositis, with no significant differences compared to patients without cancer. Both groups of patients with overall cancer and cancer-associated myositis had more respiratory comorbidities, anemia, and hypergammaglobulinemia, and dermatomyositis phenotype. Anti-TIF1-γ antibody positivity predicted cancer-associated myositis but not the overall cancer rate; malignancy was observed in particular in patients with isolated anti-TIF1-γ antibodies, while a lower prevalence occurred in case of additional specificities identified by immunoprecipitation. Recent IMACS guidelines perform well in the interception of cancer, yet adjunctive history and laboratory features should be considered. Patients with anti-TIF1-γ antibodies are at risk of cancer-associated myositis, but concurrent autoantibodies negatively correlate with malignancy and warrant characterization.

Rare but elevated incidence of hematological malignancy after clozapine use in schizophrenia: A population cohort study.

Clozapine is widely regarded as a highly efficacious psychotropic drug that is largely underused worldwide. Recent disproportionality analyses and nationwide case-control studies suggested a potential association between clozapine use and hematological malignancy (HM). Nevertheless, the absolute rate difference is not well-established due to the absence of analytic cohort studies. The clinical significance of such a potential risk remains unclear. We extracted data from a territory-wide public healthcare database from January 2001 to August 2022 in Hong Kong to conduct a retrospective cohort study of anonymized patients aged 18+ years with a diagnosis of schizophrenia who used clozapine or olanzapine (drug comparator with highly similar chemical structure and pharmacological mechanisms) for 90+ days, with at least 2 prior other antipsychotic use records within both groups. Weighted by inverse probability of treatment (IPTW) based on propensity scores, Poisson regression was used to estimate the incidence rate ratio (IRR) of HM between clozapine and olanzapine users. The absolute rate difference was also estimated. In total, 9,965 patients with a median follow-up period of 6.99 years (25th to 75th percentile: 4.45 to 10.32 years) were included, among which 834 were clozapine users. After IPTW, the demographic and clinical characteristics of clozapine users were comparable to those of olanzapine users. Clozapine users had a significant weighted IRR of 2.22 (95% confidence interval (CI) [1.52, 3.34]; p < 0.001) for HM compared to olanzapine users. The absolute rate difference was estimated at 57.40 (95% CI [33.24, 81.55]) per 100,000 person-years. Findings were consistent across subgroups by age and sex. Sensitivity analyses all supported the robustness of the results and showed good specificity to HM but no other cancers. The main limitation of this observational study is the potential residual confounding effects that could have arisen from the lack of randomization in clozapine or olanzapine use. Absolute rate difference in HM incidence associated with clozapine is small despite a 2-fold elevated rate. Given the rarity of HM and existing blood monitoring requirements, more restrictive indication for clozapine or special warnings may not be necessary.

Анализ заболеваемости солидными злокачественными новообразованиями в Уральской когорте потомков облученного населения

Purpose: The study of regularities in the incidence of solid cancer in the Urals Cohort of the Exposed Population Offspring over a 65-year follow-up period. Material and methods: The study was conducted by cohort method. The cohort under study is the Urals Cohort of the Exposed Population Offspring. It includes offspring of the population exposed in the period from 1950 to 1960 in the Southern Urals (on the Techa River and at the East Urals radioactive trace). The catchment area includes 5 districts of the Chelyabinsk region, as well as the city of Chelyabinsk and the city of Ozyorsk. The follow-up period was 65 years, from 01.01.1956 to 31.12.2020, the number of the analytical cohort for 2024 is 24952 people, the number of person-years under follow-up is 850698. Calculation of cases, incidence rates, person-years and statistical processing of data were performed by standard methods using the DATAB program module of the Epicure statistical package. Results: During the 65-year period, 569 cases of solid cancers were registered in the catchment area. In women the most frequent cases were neoplasms of female reproductive organs, breast, thyroid gland, whole intestine and upper digestive tract organs; in men - respiratory organs, upper digestive tract and whole intestine. A significant increase in the incidence rates was found in women in age groups older than 20 years and in men in groups older than 30 years. Statistically significant sex-depended differences were observed only in the age groups between 30 and 50 years. No significant differences in the incidence rates among offspring of different ethnic groups were found. An assessment of incidence rates by calendar periods was carried out: in women, a significant increase in incidence rates began in 1990, in men in 2005 and significant differences by sex were observed only in the period from 2005 to 2020. Conclusion: The study revealed patterns in the incidence of solid malignant neoplasms within the offspring cohort by sex, age and depending on the calendar period. These patterns will be taken into account in future studies when assessing the dependence of the incidence of solid malignant neoplasms in offspring on parental gonadal dose.

NSAID exposure delays time-to-pregnancy in patients with spondyloarthritis: an analysis of the GR2 prospective cohort

BackgroundThe impact of disease activity and treatment on fertility outcomes in patients with spondyloarthritis (SpA) has been little explored. This study aimed to describe median time to pregnancy (TTP) in...

Identification and validation of respiratory subphenotypes in patients with COVID-19 acute respiratory distress syndrome undergoing prone position

BackgroundThe heterogeneity of acute respiratory distress syndrome (ARDS) patients is a challenge for the development of effective treatments. This study aimed to identify and characterize novel respiratory subphenotypes of COVID-19 ARDS, with potential implications for targeted patient management.MethodsConsecutive ventilated patients with PCR-confirmed COVID-19 infection, in which prone positioning was clinically indicated for moderate or severe ARDS, were included in a prospective cohort. The patients were assigned to development or validation cohorts based on a temporal split. The PaO2/FiO2 ratio, respiratory compliance, and ventilatory ratio were assessed longitudinally throughout the first prone session. The subphenotypes were derived and validated using machine learning techniques. A K-means clustering implementation designed for joint trajectory analysis was utilized for the unsupervised classification of the development cohort. A random forest model was trained on the labeled development cohort and used to validate the subphenotypes in the validation cohort.Results718 patients were included in a prospective cohort analysis. Of those, 504 were assigned to the development cohort and 214 to the validation cohort. Two distinct subphenotypes, labeled A and B, were identified. Subphenotype B had a lower PaO2/FiO2 response during the prone session, higher ventilatory ratio, and lower compliance than subphenotype A. Subphenotype B had a higher proportion of females (p < 0.001) and lung disease (p = 0.005), higher baseline SAPS III (p = 0.002) and SOFA (p < 0.001) scores, and lower body mass index (p = 0.05). Subphenotype B had also higher levels of the pro-inflammatory biomarker IL-6 (p = 0.017). Subphenotype B was independently associated with an increased risk of 60-day mortality (OR 1.89, 95% CI 1.51–2.36). Additionally, Subphenotype B was associated with a lower number of ventilator-free days on day 28 (p < 0.001) and a lower hospital length of stay (p < 0.001). The subphenotypes were reproducible in the validation cohort.ConclusionOur study successfully identified and validated two distinct subphenotypes of COVID-19 ARDS based on key respiratory parameters. The findings suggest potential implications for better patient stratification, risk assessment, and treatment personalization. Future research is warranted to explore the utility of these novel subphenotypes for guiding targeted therapeutic strategies in COVID-19 ARDS.

Cardiorespiratory Fitness in Adolescence and Risk of Type 2 Diabetes in Late Adulthood: A Nationwide Sibling-Controlled Cohort Study.

The importance of adolescent cardiorespiratory fitness for long-term risk of type 2 diabetes (T2D) remains poorly investigated, and whether the association is influenced by unobserved familial confounding is unknown. We conducted a sibling-controlled cohort study based on all Swedish men who participated in mandatory military conscription examinations from 1972 to 1995 around the age of 18, and who completed standardized cardiorespiratory fitness testing. The outcome was T2D, defined as a composite endpoint of diagnosis in inpatient or specialist outpatient care, or dispensation of antidiabetic medication, until 31 December 2023. 1 124 049 men, of which 477 453 were full siblings, with a mean age of 18.3 years at baseline were included. During follow-up, 115 958 men (48 089 full siblings) experienced a first T2D event at a median age of 53.4 years. Compared to the first decile of fitness, higher fitness levels were associated with a progressively lower risk of T2D. In cohort analysis, the hazard ratio (HR) in the second decile was 0.83 (95% CI, 0.81 to 0.85), with a difference in the standardized cumulative incidence at age 65 of 4.3 (3.8 to 4.8) percentage points, dropping to a HR of 0.38 (0.36 to 0.39; incidence difference 17.8 [17.3 to 18.3] percentage points) in the tenth decile. When comparing full siblings, and thus controlling for all unobserved behavioral, environmental, and genetic confounders that they share, the association replicated, although with attenuation in magnitude. The HR in the second decile was 0.89 (0.85 to 0.94; incidence difference 2.3 [1.3 to 3.3] percentage points), and in the tenth decile it was 0.53 (0.50 to 0.57; incidence difference 10.9 [9.7 to 12.1] percentage points). Hypothetically shifting everyone in the first decile of fitness to the second decile was estimated to prevent 7.2% (6.4 to 8.0) of cases at age 65 in cohort vs. 4.6% (2.6 to 6.5) in full-sibling analysis. The association was similar in those with overweight as in those without. Higher levels of adolescent cardiorespiratory fitness are associated with lower risk of T2D in late adulthood, with clinically relevant associations starting already from very low levels of fitness, and similarly in those with overweight compared to those without. The association replicates, but becomes weaker, after adjusting for unobserved familial confounders shared between full siblings. This suggests that adolescent cardiorespiratory fitness is a robust marker of long-term T2D risk, but that conventional observational analysis may yield biased estimates. None. Evidence before this study: Type 2 diabetes is a growing public health issue, affecting at least half a billion people globally. Modifiable factors such as physical activity and the closely related trait cardiorespiratory fitness, which are inversely associated with type 2 diabetes, are declining, particularly among youth. Since these traits track from youth into adulthood, early-life interventions might have important implications for prevention. However, previous studies have typically focused on middle-aged individuals, leaving gaps in understanding whether fitness in youth is associated with type 2 diabetes in the long-term. Moreover, they have not been designed to adequately account for unobserved confounders. Triangulating the evidence across different methods, such as using sibling comparison analysis, would be important to obtain more accurate and reliable estimates of the causal relationship.Added value of this study: In this nationwide sibling-controlled cohort study encompassing more than 1 million young men, of which half a million were full siblings, higher levels of adolescent cardiorespiratory fitness were associated with a substantially lower risk of developing type 2 diabetes up to five decades later. The association was clinically relevant already from low levels of fitness, and it appeared similar in those with overweight as in those without overweight. While the association replicated after adjusting for unobserved familial confounders shared between full siblings, the magnitude of association attenuated by an amount that appeared clinically relevant. For example, the incidence differences between deciles of fitness were about 40% smaller in sibling-comparison analyses as compared to cohort analysis, and the preventable share of type 2 diabetes associated with hypothetical interventions shifting the population-level of fitness was reduced by about one-third.Implications of all the available evidence: Adolescent cardiorespiratory fitness is a strong marker of long-term risk of type 2 diabetes, both in those with and without overweight. These findings render support to large-scale surveillance of fitness from a prevention perspective, and if the findings are confirmed using other lines of causal analysis, they may render support to interventions targeting fitness already from a young age. Yet, these findings also highlight the importance of triangulation for obtaining more reliable evidence of the magnitude of association, and shed light on the pitfalls of conventional observational analysis which may yield biased estimates.

Exploring the Obesity Paradox in All Subtypes of Intracranial Hemorrhage: A Retrospective Cohort Analysis of 13,000 Patients.

Recent studies reveal an "obesity paradox", suggesting better clinical outcomes after intracranial hemorrhage for obese patients compared to patients with a healthy BMI. While this paradox indicates improved survival rates for obese individuals in stroke cases, it is unknown whether this trend remains true across all forms of intracranial hemorrhage. Therefore, the objective of our study was to investigate the incidence, characteristics, and outcomes of hospitalized obese patients with intracranial hemorrhage. The National Inpatient Sample (NIS) database was queried for data from 2015 to 2019 to identify adult patients aged 18 years and older with a primary diagnosis of non-traumatic intracranial hemorrhage. Using International Classification of Disease 10th Edition codes, patients were stratified by BMI categories: healthy weight, overweight, class I-II obesity, and class III obesity. The cohorts were examined for demographic characteristics, comorbidities, stroke severity, inpatient complications, interventions, and clinical outcomes, including length of stay (LOS), discharge disposition, and inpatient mortality. Of 41,960 intracranial hemorrhage patients identified, 13,380 (33.0%) also had an obese BMI. Class I-II obese intracranial hemorrhage patients were more likely to be of white race (OR: 1.101, 95% CI: 1.052, 1.152, p < 0.001), less likely to be female (OR: 0.773, 95% CI: 0.740, 0.808, p < 0.001), and more likely to have diabetes mellitus (OR: 1.545, 95% CI: 1.477, 1.616, p < 0.001) and hypertension (OR: 1.828, 95% CI: 1.721, 1.943, p < 0.001) in comparison to healthy-weight patients. In a matched cohort analysis adjusting for demographics and severity, intracranial hemorrhage patients with class I-II obesity had a shorter length of stay (LOS) (OR 0.402, 95% CI: 0.118, 0.705, p < 0.001), reduced inpatient mortality (OR 0.847, 95% CI: 0.798, 0.898, p < 0.001), and more favorable discharge disposition (OR 1.395, 95% CI: 1.321, 1.474, p < 0.001) compared to their healthy-weight counterparts. Furthermore, these patients were less likely to require decompressive hemicraniectomy (OR 0.697, 95% CI: 0.593, 0.820, p < 0.001). Following an analysis of individual ICH subtypes, obese subarachnoid hemorrhage (SAH) patients demonstrated reduced mortality (OR: 0.692, 95% CI: 0.577-0.831, p < 0.001) and LOS (OR: 0.070, 95% CI: 0.466-0.660, p = 0.039), with no differences in discharge disposition. Similarly, intracerebral hemorrhage patients demonstrated reduced mortality (OR: 0.891, 95% CI: 0.827-0.959, p = 0.002) and LOS (OR: 0.480, 95% CI: 0.216-0.743, p < 0.001). Other ICH subtypes showed improved discharge outcomes (OR: 1.504, 95% CI: 1.368-1.654, p < 0.001), along with decreased mortality (OR: 0.805, 95% CI: 0.715-0.907, p < 0.001) and LOS (OR: -10.313, 95% CI: -3.599 to -2.449, p < 0.001). Intracranial hemorrhage patients with class I-II obesity exhibited more favorable clinical outcomes than those who were of a healthy weight or overweight. Despite its association with risk factors contributing to intracranial hemorrhage, class I-II obesity was associated with improved outcomes, lending support to the existence of the obesity paradox in stroke.

Factors influencing postoperative urinary retention after radical hysterectomy for cervical cancer: development and validation of a predictive model in a prospective cohort study in Southwest China

ObjectivesTo explore influencing factors for postoperative urinary retention (POUR) in cervical cancer patients and construct and validate a POUR prediction model.DesignA prospective cohort study.SettingA large tertiary hospital specialised in child...

The Role of Trace Elements in COPD: Pathogenetic Mechanisms and Therapeutic Potential of Zinc, Iron, Magnesium, Selenium, Manganese, Copper, and Calcium.

Chronic obstructive pulmonary disease (COPD) is a progressive, inflammatory airway disorder characterized by a gradual decline in lung function and increased oxidative stress. Both oxidative stress and inflammation are central to its pathophysiology, with trace elements such as zinc, copper, iron, manganese, magnesium, selenium, and calcium playing key roles in various cellular processes. This article reviews the role of trace elements in COPD, focusing on their involvement in disease pathogenesis and their therapeutic potential. Specifically, we examine the effects of zinc, copper, iron, magnesium, manganese, selenium, and calcium in COPD. We performed a comprehensive narrative review of the literature across databases including PubMed, Web of Science, Cochrane Library, and Google Scholar, identifying studies that explore the therapeutic effects of trace elements in COPD. The studies included in the review consisted of cohort analyses, randomized controlled trials, and clinical investigations. Zinc, copper, iron, magnesium, manganese, selenium, and calcium are critical to both the pathophysiology and management of COPD. These trace elements contribute to the regulation of inflammation, the modulation of oxidative stress, and the maintenance of lung function. Zinc and copper, for instance, reduce oxidative stress and modulate immune responses, while iron is essential for oxygen transport. Magnesium, manganese, selenium, and calcium are vital for muscle function, respiratory performance, reducing inflammation, and improving pulmonary function. The minerals zinc, copper, iron, magnesium, manganese, selenium, and calcium may contribute to beneficial effects as part of the standard therapeutic management of COPD. Maintaining optimal levels of these trace elements may support the regulation of inflammatory processes, a reduction in oxidative stress, and an improvement in the pulmonary function. However, further clinical research is necessary to confirm their efficacy and establish safe dosage recommendations in COPD treatment.