The inflammatory biomarker, soluble urokinase plasminogen activator receptor (suPAR), has emerged as a promising prognostic biomarker in cardiovascular diseases. However, little is known about suPAR levels in patients admitted with acute heart failure (AHF). This study investigates the prevalence and prognostic value of elevated suPAR in patients hospitalized with AHF. This cohort study included patients presenting with cardiopulmonary symptoms at the Medical Emergency Department of University Hospital Amager-Hvidovre, Denmark, between March 10, 2020, and March 31, 2022. SuPAR was measured upon admission, with the median time from admission to measurement of two hours (IQR 3.9 - 6.9). A cardiologist adjudicated whether the patients had AHF. Patients were stratified according to validated cut-off values of suPAR <6ng/ml and≥6ng/ml. Kaplan-Meier survival analysis and Cox regression were used to assess the association between suPAR levels and one-year mortality. A total of 386 (3.8%) AHF patients, from a total population of 10,027, were included. The mean suPAR value was significantly higher among AHF patients compared to non-AHF patients: 6.2ng/ml (standard deviation [SD]=4.8ng/ml) vs 4.4ng/ml (SD=2.9ng/ml), p<0.001. A suPAR level≥6ng/ml was significantly associated with mortality, log-rank-p-value <0.0001. Furthermore, Cox regression analysis demonstrated that elevated suPAR levels were independently associated with increased risk of mortality with a hazard ratio (HR): 1.06 (95% CI: 1.03-1.1, p<0.001) after adjusting for potential confounders. SuPAR levels measured at hospital admission in AHF patients correlate significantly with one-year mortality and outperform C-reactive protein, supporting their potential role in early prognostication to identify high-risk patients.

Establishment of trimester-specific reference intervals for hemostatic and hematologic indices and their associations with adverse pregnancy outcomes.

Genetic epilepsies include a broad spectrum of disorders caused by pathogenic variants in more than 1,000 genes. Their clinical expression is highly variable, making early phenotype-genotype interpretation challenging. Early seizure semiology and EEG features may offer clinically useful information for diagnostic orientation and management. The aim of this study was to characterize early clinical and EEG features in patients with genetic epilepsies, examine their associations with outcomes, and explore genotype-phenotype groupings through hierarchical clustering analysis (HCA). We conducted a retrospective study at Bambino Gesù Children's Hospital. Eligible participants carried pathogenic or likely pathogenic variants in epilepsy-related genes, identified through medical records and laboratory diagnostic logs. Clinical variables at seizure onset and EEG recordings performed within the first month of the initial seizure were extracted. Follow-up outcomes included seizure frequency, drug resistance, movement disorders, behavioral/autism spectrum disorder comorbidities, and developmental delay/intellectual disability (DD/ID). Associations between early features and outcomes were assessed using χ2 or Fisher tests. HCA was used to identify clusters linking early phenotype and gene-level etiology. We included 277 patients (52.3% female; median age at last follow-up 8.1 years, range 0-40). Drug resistance occurred in 58.8% and severe DD/ID in 35.4% of patients. EEG data at onset were available for 107 individuals. Neonatal onset was associated with a higher rate of drug resistance (71.4%; odds ratio [OR] 2.0, 95% CI 1.05-3.77), movement disorders (60.7%; OR 3.7, 95% CI 2.02-6.82), and severe DD/ID (71.4%; OR 7.0, 95% CI 3.66-13.49). Slow EEG background activity and multifocal epileptiform discharges were associated with both drug resistance and severe DD/ID. HCA identified genotype-phenotype groupings, including clusters involving SCN1A, PRRT2, STXBP1, KCNQ2, SCN2A, CHD2, SYNGAP1, and MECP2, each linked to specific clinical and EEG features. Early clinical and EEG features showed meaningful associations with outcomes and mapped onto specific genetic etiologies. HCA revealed coherent genotype-phenotype clusters that may support early diagnostic reasoning. Limitations include the retrospective design and small numbers per gene, warranting larger multicenter studies for validation.

Approximately 450,000 Veterans are living with Alzheimer disease and related dementias (ADRD), and the high prevalence of ADRD represents a major public health challenge for the Veterans Health Administration. While advancing age and genetic predisposition are well-established ADRD risk factors, growing evidence suggests that additional modifiable factors may also play an important role. This study leveraged data from the VA Million Veteran Program (MVP) to (1) estimate 10-year incidence of ADRD and (2) evaluate associations between a broad range of individual-level risk and resilience factors and incident ADRD in a large, nationally representative sample of Veterans. This retrospective cohort study included Veterans aged ≥65 years at MVP enrollment who completed the MVP Baseline Survey and had VA electronic health record (EHR) data available. Individual-level variables including sociodemographic factors, military-specific characteristics, military environmental exposures (MEEs), health conditions, and health behaviors were characterized using MVP Baseline Survey data and supplemented with EHR data as available. The primary outcome was ADRD, which was determined using a validated algorithm based on International Classification of Diseases diagnosis codes extracted from the EHR. Associations between each risk/resilience factor and incident ADRD were examined using separate Cox regression models adjusted for age, sex, and education. The sample included 245,949 Veterans (age: mean 73.16, SD 6.84 years; 2.59% female). Approximately 4.56% (n = 11,216) of the sample developed ADRD over 10 years. History of traumatic brain injury (TBI; hazard ratio [HR] 2.96, 95% CI 2.76-3.17), depression (HR 2.93, 95% CI 2.82-3.04), and alcohol use disorder (AUD; HR 2.35, 95% CI 2.19-2.53) were the health factors most strongly associated with ADRD. ADRD risk was also elevated among Veterans with a history of exposure to Agent Orange (HR 1.09, 95% CI 1.03-1.14), chemical/biological warfare agents (HR 1.31, 95% CI 1.23-1.39), and pyridostigmine bromide tablets (HR 1.67, 95% CI 1.44-1.93). Findings identified TBI, depression, AUD, and MEEs as key variables associated with ADRD in Veterans. These factors may represent important targets for prevention and intervention efforts aimed at improving the long-term health of aging Veterans. Additional work is needed to clarify the mechanisms through which these factors influence ADRD risk and to establish whether observed associations are causal.

Blood-based biomarkers offer a widely available, scalable, and noninvasive method to study neurodegeneration. However, the association between blood-based biomarkers of neurodegeneration and long-term risk of mortality, as well as dementia-specific mortality in a racially diverse cohort, remains understudied. The goal of this study was to determine whether baseline biomarkers of neurodegeneration are associated with long-term risk of all-cause and dementia-specific mortality in a biracial cohort. The REasons for Geographic and Racial Differences in Stroke cohort study enrolled 30,239 Black and White participants across the continental United States from 2003 to 2007, with ongoing follow-up. Plasma neurofilament light chain (NfL), total tau, glial fibrillary acidic protein (GFAP), and ubiquitin carboxy-terminal hydrolase L1 (UCH-L1) were measured in baseline plasma from a random sample of participants. All-cause mortality, dementia-specific mortality, cardiovascular-specific mortality, and other causes of death were adjudicated and classified using medical records, the Social Security Death Index, and the National Death Index. Cause-specific Cox regression models accounting for competing risks were used to calculate hazard ratios (HRs) of outcomes for each biomarker separately. A total of 917 participants had a mean baseline age of 67.4 years (SD 12.1), 49.4% were female, and 48.6% self-identified as Black. With a mean follow-up of 11.1 (SD 5.7) years, 51.0% (477/935) of participants died and 9.2% experienced dementia-specific mortality (86/935). No associations were observed for total tau. In fully adjusted models for other biomarkers, HRs of all-cause mortality per standard deviation increments were 1.93 (95% CI 1.48-2.52) for GFAP, 1.90 (95% CI 1.55-2.32) for NfL, and 1.23 (95% CI 1.09-1.37) for UCH-L1. Furthermore, GFAP (HR 5.66, 95% CI 2.91-11.00) and NfL (HR 2.72, 95% CI 1.57-4.71) were associated with dementia-specific mortality in fully adjusted models. GFAP (HR 2.06, 95% CI 1.22-3.49) and NfL (HR 2.16, 95% CI 1.66-2.81) were also associated with cardiovascular-specific mortality in fully adjusted models. Plasma biomarkers of neurodegeneration, particularly GFAP and NfL, were associated with increased risk of all-cause, dementia-specific, and cardiovascular-specific mortality in a biracial cohort. These associations should be considered when assessing links between these biomarkers and other outcomes, as well as when used in clinical practice.

Seizures are common in patients with brain metastases (BMs), causing significant morbidity and reduced quality of life. The relationship between BM location and seizure risk remains unclear. Nononcologic literature suggests that primary motor cortex disruption may predispose to seizures. This study evaluated whether BM in primary motor cortex display increased seizure risk relative to BM in other locations. In this retrospective cohort study, patients with radiographic evidence of BM managed at Brigham and Women's Hospital/Dana-Farber Cancer Institute between 2003 and 2022, and maintained in a database, were included. Abstracted covariables spanned demographic (age, sex, and race), clinical (comorbidities and performance status), oncologic (cancer type, extracranial/intracranial disease extent, and prior systemic therapy), radiotherapeutic/neurosurgical (employment and type of radiation, presence of preceding brain-directed surgery), and outcome/seizure-related (presence, timing, and nature of seizures) domains. The exposure variable was BM in the primary motor cortex, and the outcome measure was seizures on a per-patient level. The effect of primary motor cortex involvement on seizure risk, at diagnosis and thereafter, was evaluated using univariable/multivariable logistic, and Fine and Gray competing risks regression, respectively. To limit confounding by lesion number, analyses were repeated in patients with a single BM at diagnosis (n = 1,174). Among 3,043 patients with (n = 570, 18.7%) vs without (n = 2,473, 81.3%) BM in primary motor cortex, the mean age was 60 vs 61 years, and 61% vs 62% of patients were female, respectively. Primary motor cortex involvement was associated with increased seizure risk at diagnosis (24.4% vs 10.3%, odds ratio 2.87, 95% CI 2.23-3.98, p < 0.001) and after initial diagnosis (hazard ratio [HR] 1.95, 95% CI 1.56-2.43, p < 0.001). Of 1,446 patients who developed additional BM after initial intracranial oncologic involvement, those with disease involving primary motor cortex were more likely to develop seizures thereafter (HR 2.11, 95% CI 1.56-2.86, p < 0.001). Patients with BM in the primary motor cortex may display increased seizure risk. As this study was retrospective, routine use of antiseizure medications in patients with BM in primary motor cortex in the off-trial setting is not recommended. However, dedicated trials evaluating prophylactic antiseizure medications in this population may be warranted.

Traumatic brain injury (TBI) mechanisms are often grouped together in research. Differences in acute and long-term outcomes across mechanisms of injury (MOIs) remain unclear, partly because of confounding by age. Modeling MOI-specific effects can inform clinical triage and prognostication. We examined the relationship between motor vehicle accidents (MVAs) vs falls, the 2 most common MOIs, and acute and 1-year post-injury outcomes, after rigorous control of demographic and preinjury personal factors. Data were analyzed from individuals with moderate-to-severe TBI requiring inpatient rehabilitation from the TBI Model Systems National Database, a multicenter prospective longitudinal cohort study. The analytic sample was restricted to individuals aged 16-79 years with an MOI due to MVA or fall occurring between April 2010 and January 2023. We used inverse probability of treatment weighting, based on propensity scores, to adjust for 14 demographic and preinjury personal characteristics and estimate the causal effect of MOI on acute and 1-year outcomes after TBI. Acute hospital and rehabilitation outcomes included the following: Glasgow Coma Scale (GCS), sedation, intubation, post-traumatic amnesia duration, time to follow commands (TFC), length of hospital stay (LOS), and Functional Independence Measure (FIM) cognitive and motor scores. One-year outcomes included the following: Disability Rating Scale and Participation Assessment with Recombined Tools Objective. Among 5,181 participants (mean age 45.1 ± 19.5, 70% male), 48.4% sustained their injury from MVAs and 51.6% from falls. After weighting and multiple comparisons adjustment, the MVA group had lower GCS total scores by 1.27 points (95% CI -1.92 to -0.61; adjusted p = 0.001), greater odds of receiving sedation (odds ratio 1.43, 95% CI 1.11-1.85; adjusted p = 0.014), longer TFC by 1.64 days (95% CI 0.39-2.89; adjusted p = 0.017), and lower discharge FIM motor scores by 4.28 points (95% CI -7.50 to -1.26; adjusted p = 0.014). At 1 year after injury, disability levels and community participation did not differ. MVA-related TBI was associated with worse acute outcomes. However, by 1 year after injury, disability level and community participation do not differ. This work highlights novel findings in short-term and long-term outcomes after falls and MVAs, the leading TBI causes, which are not explained by confounders such as age. Findings may not generalize beyond patients receiving inpatient rehabilitation for TBI.

Comparison of baloxavir/marboxil treatment and treatment with other anti-influenza agents in adult patients hospitalized for influenza: An internet-based, prospective, multicenter, cohort study in Japan.

Does clockwise rotation of the maxillomandibular complex using the surgery-first approach to correct mandibular prognathism affect the pharyngeal airway?

Long-term variability in physiological measures and risk of frailty: evidence from two cohort studies.

Long-term impact of the COVID-19 pandemic on childhood vaccination coverage in Quebec, Canada: A cohort study from the Canadian immunization research network.

Comparison of rTMS and esketamine for treatment-resistant depression: A target trial emulation.

Acute myocardial infarction following allogeneic hematopoietic stem cell transplantation: A national cohort study.

Clinician-level variation in lipid management for secondary prevention of atherosclerotic cardiovascular disease: Opportunities for practice improvement.

Socioeconomic status and intrinsic capacity trajectories among middle-aged and older adults in China: mediating role of cognitive leisure activities.

Body mass index-adjusted calf circumference and mid-arm muscle circumference are associated with hospital stay in overweight patients: A cohort study.

To investigate the association between the initiation of strong chū-hai-an inexpensive Japanese ready-to-drink beverage with high-alcohol-content-consumption and the newly incident hazardous and harmful alcohol use among individuals who consume alcohol. This cohort study is based on a three-year longitudinal internet survey conducted in Japan from 2022 to 2024. Respondents who completed all three annual surveys, did not drink strong chū-hai in 2022, and consumed alcohol without presenting hazardous or harmful alcohol use in both 2022 and 2023, were included. The outcome was defined as having newly developed hazardous and harmful alcohol use in 2024, defined as a score of ≥ 8 on the Alcohol Use Identification Test. We fitted a multivariable logistic regression model to examine confounder-adjusted association between initiating strong chū-hai consumption and the incidence of hazardous and harmful alcohol use. Of 5358 respondents from 33,000 surveyed in 2022, approximately 10 % (n = 533) initiated strong chū-hai consumption in 2023. In 2024, the prevalence of hazardous and harmful alcohol use was higher for those who initiated strong chū-hai consumption (7.7 %) than those who did not (3.1 %). Multivariable analysis revealed that initiating strong chū-hai consumption was associated with higher odds of hazardous and harmful alcohol use the year following (adjusted odds ratio 1.90, 95 % confidence interval 1.19-3.06, p = 0.008). The initiation of strong chū-hai consumption was associated with the incidence of hazardous and harmful alcohol use. Considering the global increase in sales of ready-to-drink alcoholic beverages, our findings serve as an important caution for policymakers worldwide.

The emergence of antimicrobial resistance raises concerns about using antibiotics in veterinary medicine, particularly in cases of bronchopneumonia in foals diagnosed early based on a screening programme. Many subclinical foals recover spontaneously, thus, interest in more restrictive antibiotic usage is increasing. To determine whether initiating antimicrobial therapy at a later stage of bronchopneumonia decreases antimicrobial usage without compromising successful resolution of pathology in affected foals. A total of 1200 warmblood foals born in 2020, 2022, 2023 and 2024 on a single stud farm, all diagnosed with bronchopneumonia, were investigated. All foals in this cohort study were randomly selected and underwent clinical, haematological and thoracic ultrasonographical examinations once weekly. Diagnosis of bronchopneumonia required a total abscess score (sum of abscess diameters) ≥ 1.0 cm. Treatment thresholds were ≥ 15.0 cm in 2020/2022 and ≥ 20.0 cm in 2023/2024. Treated foals (n = 279) received rifampin/tulathromycin. Treatment duration, recurrence and failure were compared statistically between early and later treatment groups. The proportion of foals treated decreased significantly from 29.0 % in 2020/2022-17.5 % in 2023/2024, whilst mortalities remained unchanged (both 1.0 %). There was no statistical difference in the proportions of foals with treatment failure (2.8 % in 2020/2022 vs. 8.6 % in 2023/2024) and recurrence (2.3 % in 2020/2022 vs. 0.95 % in 2023/2024). The initial treatment duration increased from 21 (2020/2022) to 25 days (2023/2024). Delaying antimicrobial treatment until foals exhibit more advanced pulmonary lesions significantly reduced the proportion of foals treated. Failure, recurrence and mortality remained comparable.

SARS-CoV-2 reinfections and subsequent risk of hospital-diagnosed post-acute sequelae in Denmark (2020-2022): a nationwide cohort study.

Assessment of survival and clinicopathologic characteristics associated with lymph node isolated tumor cells in epithelial ovarian cancer.