Confidence Interval CI Research Articles

Impact of the COVID-19 Pandemic on Childhood Lead Testing and Blood Lead Levels

ObjectiveTo evaluate the effect of the COVID-19 pandemic on childhood lead testing and blood lead levels. MethodsA retrospective analysis of lead tests and results was performed across 3 urban medical centers during the pre-COVID-19 (March 10, 2019–March 9, 2020) and COVID-19 (March 10, 2020–March 10, 2022) periods. Interrupted time series analysis with quasi-Poisson regression was used to evaluate changes in lead testing between study periods. The relationship between sociodemographic features with detectable (≧2 µg/dL) and elevated (≧3.5 µg/dL) blood lead levels (BLLs) was assessed with multivariable logistic regression. ResultsAmong a total of 16,364 lead tests across 10,362 patients, weekly testing rates significantly decreased during COVID-19 (relative risk (RR) 0.64, 95% (confidence interval) CI 0.53–0.78). Census tracts with the greatest proportion of pre-1950s housing had a stronger association with detectable BLLs during the COVID-19 period (pre-COVID-19 adjusted odds ratio (aOR) 1.73, 95% CI 1.35–2.20; aOR 2.58, 95% CI 2.13–3.12; interaction P value .014). When limited to 1 year following COVID-19 (March 10, 2020–March 10, 2021), the association between both elevated BLLs (pre-COVID-19: aOR 1.49, 95% CI 0.87–2.53; COVID-19: aOR 3.51, 95% CI 1.98–6.25; interaction P value .032) and detectable BLLs with pre-1950s housing were greater during the COVID-19 period (pre-COVID-19: aOR 1.73, 95% CI 1.35–2.20; COVID-19: aOR 2.56, 95% CI 1.95–3.34; interaction P value .034). ConclusionsThe COVID-19 pandemic led to a significant reduction in lead surveillance and magnified the effect of known risk factors for lead exposure. Concerted clinical, public health, and community advocacy are needed to address care gaps and excess cases of lead poisoning.

Sodium-glucose cotransporter-2 inhibition for heart failure with preserved ejection fraction and chronic kidney disease with or without type 2 diabetes mellitus: a narrative review

BackgroundHeart failure (HF), chronic kidney disease (CKD), and type 2 diabetes mellitus (T2DM) are common and interrelated conditions, each with a significant burden of disease. HF and kidney disease progress through pathophysiologic pathways that culminate in end-stage disease, for which T2DM is a major risk factor. Intervention within these pathways can disrupt disease processes and improve patient outcomes. Sodium-glucose cotransporter-2 inhibitors (SGLT2is) have been investigated in patient populations with combinations of T2DM, CKD, and/or HF. However, until recently, the effect of these agents in patients with HF with preserved ejection fraction (HFpEF) was not well studied.Main bodyThe aim of this review is to summarize key information regarding the interaction between HFpEF, CKD, and T2DM and discuss the role of SGLT2 inhibition in the management of patients with comorbid HFpEF and CKD, with or without T2DM. Literature was retrieved using Boolean searches for English-language articles in PubMed and Google Scholar and included terms related to SGLT2is, HFpEF, T2DM, and CKD. The reference lists from retrieved articles were also considered. ConclusionSGLT2is are efficacious and safe in treating HFpEF in patients with comorbid CKD with and without T2DM. The totality of evidence from clinical trials data suggests there are benefits in using SGLT2is across the spectrum of left ventricular ejection fractions, but there may be a potential for different renal effects in the different ejection fraction groups. Further analysis of these clinical trials has highlighted the need to obtain more accurate phenotypes for patients with HF and CKD to better determine which patients might respond to guideline-directed medical therapies, including SGLT2is.Graphical CI confidence interval, EF ejection fraction, eGFR estimated glomerular filtration rate, HF heart failure, HHF hospitalization for HF, HR hazard ratio, LVEF left ventricular ejection fraction, SGLT2i sodium-glucose cotransporter-2 inhibitor, UACR urine albumin-creatinine ratio. a Mean value, unless otherwise stated, b SGLT2i vs. placebo, c Data reanalyzed using more conventional endpoints (≥ 50% sustained decrease in eGFR, and including renal death) (UACR at baseline not stated in trial reports)

Cancer care to the population of Russia in 2022

Objective: to analyze cancer statistics in Russia as a whole, as well as in individual regions of the Russian Federation.Material and Methods. Based on data from the state medical statistics according to the form No. 7 “information on malignant neoplasms for 2022” the crude and standardized rates, standard error of crude and standardized rates, confidence intervals (ci) for 2022, and the qualitative parameters of cancer care were calculated.Results. in 2022, 624,835 new cancer cases were detected in the Russian Federation (283,179 in men and 341,656 in women), in increase of 7.6 % compared to 2021 (in 2021: 580415), and decrease of 2.4 % compared to 2019 (in 2019: 640391). in 2022, the crude incidence rate was 425.89 ± 0.54 per 100,000 population of Russia (ci: 424.83–426.95 per 100,000 population), which was 7.0 % higher than that in 2021 (in 2021 – 397.91 ± 0.54 per 100,000 population) but 2.4 % lower than in 2019 (in 2019 – 436.34 ± 0.52 per 100,000 population). the standardized incidence rate was 236.47 ± 0.32 per 100,000 population (ci: 235.84–237.10 per 100,000 population), which was 5.2 % higher compared to that observed in 2021 (in 2021 – 224.87 ± 0.32 per 100,000 population) but 5.2 % lower than in 2019 (in 2019 – 249.54 ± 0.33 per 100,000 population). the prevalence rate of cancer in 2022 was 2,742.4 per 100,000 population of Russia, an increase in the prevalence rate over 10 years was 33.9 %.Conclusion. Сancer care in the Russian Federation in 2022 was provided at the proper level. there is a positive trend in the early detection of cancer, which partly influences the reduction in the one-year mortality rate.

Risk Prediction of Metachronous Colorectal Cancer from Molecular Features of Adenomas: A Nested Case-Control Study.

Identifying new biomarkers may improve prediction of me-CRC for individuals with adenomas and optimize surveillance intervals to reduce risk of colorectal cancer and reduce oversurveillance of patients with low risk of colorectal cancer. Use of DNA CNAs alone does not improve prediction of me-CRC. Further research to improve risk classification is required.

Genetic association between atopic disease and osteoarthritis

To evaluate the association between genetically determined risk for atopic disease and osteoarthritis (OA). We performed linkage disequilibrium (LD) score regressionusing 1000 Genomes Project European samples as a reference for patterns of genome-wide LD. Summary statistics for atopic disease traits were obtained from the UK Biobank. We generated a pairwise genetic correlation between OA and traits for atopic disease to estimate the genetic correlation between traits (rg) and heritability for each trait. The association between atopy-related traits and OA was examined using Mendelian randomization (MR) on summary statistics; we reported inverse-variance weighted (IVW), MR-Egger, maximum likelihood estimation, weighted median, and weighted mode. There was a significant positive correlation between the genome-wide genetic architecture of asthma and all OA traits. Using the IVW (random effects), there was a significant association between asthma and knee OA ((odds ratio) OR=1.04, 95% (confidence interval) CI 1.01-1.08, p=0.0169). Using IVW (fixed effects), significant associations were identified between knee OA and allergic disease (OR=1.07, 95% CI 1.01-1.14, p=0.0342), allergic rhinitis (OR=1.07, 95% CI 1.00-1.13, p=0.0368), and asthma (OR=1.04, 95% CI 1.01-1.07, p=0.0139), as well as for OA at any site and asthma (OR=1.02, 95% CI 1.00-1.04, p=0.0166). We found a significant correlation between the overall genetic architecture of asthma and OA, as well as an increased risk of developing OA in patients with genetic variants associated with asthma and allergic rhinitis; predominately, this risk was for the development of knee OA. These results support a causal relationship between asthma and/or allergic rhinitis and knee OA.

Influence of hot-dip galvanization on the fatigue performance of high-strength bolted connections

In the present work, the influence of hot-dip galvanization (HDG) on the fatigue behaviour of high-strength bolted details is investigated through a set of 15 constant-amplitude tests. Cyclic behaviour of coated specimens is hence compared against results for unprotected samples drawn from literature, i.e., both with reference to neutral and aggressive exposure conditions. Namely, while behaviour of coated samples is moderately inferior as respect to uncoated ones in dry air (–6 % in terms of characteristic fatigue strength, probability of failure PF = 5 %, confidence interval CI = 75 %), their performance still complies with European normative requirements for double covered joints, and galvanization proves to be highly effective when corrosion is likely to occur (with a characteristic strength increase of [+12 %; +52 %]). Finally, fractography analyses on both uncoated and coated specimens were performed, suggesting that hydrogen embrittlement may play a role in reducing fatigue strength of coated joints, that is, especially within the high-cycle fatigue regime.

Real-World Evidence of Multiple Air Pollutants and Mortality: A Prospective Cohort Study in an Oldest-Old Population.

We aimed to report real-world longitudinal ambient air pollutants levels compared to WHO Air Quality Guidelines (AQG) and analyze multiple air pollutants' joint effect on longevity, and the modification and confounding from the climate and urbanization with a focus on the oldest-old. This study included 13,207 old participants with 73.3% aged 80 and beyond, followed up from 2008 to 2018 in 23 Chinese provinces. We used the Cox-proportional hazards model and quantile-based g-computation model to measure separate and joint effects of the multiple pollutants. We adjusted for climate and area economic factors based on a directed acyclic graph. In 2018, no participants met the WHO AQG for PM2.5 and O3, and about one-third met the AQG for NO2. The hazard ratio (HR) for mortality was 1.07 (95% confidence interval-CI: 1.05, 1.09) per decile increase in all three pollutants, with PM2.5 being the dominant contributor according to the quantile-based g-computation model. In the three-pollutant model, the HRs (95% CI) for PM2.5 and NO2 were 1.27 (1.25, 1.3) and 1.08 (1.05, 1.12) per 10 μg/m3 increase, respectively. The oldest-old experienced a much lower mortality risk from air pollution compared to the young-old. The mortality risk of PM2.5 was higher in areas with higher annual average temperatures. The adjustment of road density considerably intensified the association between NO2 and mortality. The ambient PM2.5 and O3 levels in China exceeded the WHO AQG target substantially. Multiple pollutants coexposure, confounding, and modification of the district economic and climate factors should not be ignored in the association between air pollution and mortality.

Abstract 14303: COVID-19 and the Gender Impact on Sudden Cardiac Death

Background: Sudden Cardiac Death (SCD) is an unexpected death attributed to a cardiac cause that occurs within one hour of symptom onset. Males have a higher likelihood of experiencing sudden cardiac arrest compared to females, as evidenced by previous studies indicating a substantial disparity in mortality rates between the genders. The outbreak of the COVID-19 pandemic has had a profound impact on cardiovascular population health patterns. Therefore, our study aimed to assess the influence of the pandemic on the gender-related variation in SCD rates among males and females. Methods: We used the National Inpatient Sample (NIS) to identify all patients admitted to hospitals in 2019 and 2020 with a primary diagnosis of sudden cardiac arrest. To analyze associations, we employed both logistic and linear regression methods, adjusting for potential confounding variables. We set the threshold for statistical significance at a 2-tailed p-value of 0.05. Results: Between 2019 and 2020, a total of 27,430 individuals were admitted to hospitals with a primary diagnosis of sudden cardiac arrest, with 11,705 (42.7%) of these patients being female. When factors such as age, race, hospital bed size, location and teaching status, insurance, and income level, as well as Elixhauser comorbidities and COVID-19 status were considered through multivariate regression analysis, a distinct trend emerged. In the year 2020, which was marked by the COVID-19 pandemic, there was a significant increase in in-hospital mortality among female patients (adjusted Odds Ratio aOR 1.34, 95% Confidence Interval CI 1.04 - 1.79). This trend was not present in the previous year, 2019, prior to the pandemic (aOR 1.03, 95% CI 0.87 - 1.22). Conclusion: Our study revealed a significant increase in mortality among female patients presenting with sudden cardiac arrest during the Covid-19 pandemic. We attribute this increase to the intricate interplay between Covid-19 and the healthcare system. While a direct association between SCD and Covid-19 is possible, it is crucial to acknowledge the indirect ramifications such as the impact of lockdown measures, alterations in behavior, and challenges faced by the healthcare system, all of which may be contributing factors.

Correlation between Progression-Free Survival and Overall Survival in Patients with Relapsed Hodgkin Lymphoma: An Analysis of Individual Patient Data from Randomized GHSG Trials

Background: Progression-free survival (PFS) and overall survival (OS) are predominant measures of treatment efficacy in Hodgkin lymphoma (HL). Despite preference for OS from many regulatory authorities, PFS is most relevant to patients and frequently serves as primary endpoint in clinical trials. Recently we found a strong correlation between treatment effects on PFS and OS in the first-line setting (Bröckelmann PJ et al. EHA23/ICML23). However, their relationship in the relapsed setting remains unclear. We aimed to evaluate the correlation of PFS with OS after treatment of relapsed HL. Methods: We evaluated individual patient data of 375 patients with relapsed HL treated within the prospective randomized GHSG trials HDR1 (N= 141) and HDR2 (N= 234) between 02/1993 - 06/2007. Briefly, both trials included patients of 18 to 60 years of age with histologically confirmed relapsed HL after ≥1 prior line of treatment, who had not previously received high-dose chemotherapy and autologous stem-cell transplantation (ASCT). In HDR1 patients received two cycles of Dexa-BEAM (dexamethasone, carmustine, etoposide, cytarabine, and melphalan) and either two further courses of Dexa-BEAM or high-dose BEAM and ASCT. In HDR2, patients were assigned to two cycles of dexamethasone, cytarabine, and cisplatin (DHAP), and thereafter randomly assigned to either BEAM followed by ASCT or sequential cyclophosphamide, methotrexate, and etoposide in high-doses before BEAM followed by ASCT. All patients who received at least one dose of salvage chemotherapy within the respective trial were included in the analysis. We correlated treatment effects and risk factor effects on PFS and OS with the Wei-Lin-Weissfeld (WLW) method and adjusted the analysis for age and sex. Additionally, we applied copula models to correlate the time-to-event variables PFS and OS themselves using their marginal distributions. Results: With a median follow-up of 4.5 years, at least one PFS event, defined as relapse or progression of relapsed HL or death for any reason, was recorded in 146 of 375 patients (38.9%). At least one OS event, defined as death for any reason, was documented in 111 of 375 patients (29.6%). The hazard ratios for treatment effects on PFS and OS were 0.61 (95% confidence interval, CI= 0.38-0.98) and 1.01 (95% CI= 0.63-1.63) for HDR1 and 1.1 (95% CI= 0.69-1.75) and 0.8 (95% CI= 0.44-1.47) for HDR2, respectively. The WLW analysis revealed high correlations of treatment effects on PFS and OS at patient level within the trials. Pearson correlation r of the treatment effects on PFS and OS were r= 0.72 (95% confidence interval CI= 0.66-0.76, P< 0.001) in all 375 patients analyzed, r= 0.72 (95% CI= 0.63-0.79, P<0.001) in the HDR1 trial and r= 0.74 (95% CI= 0.67-0.79, P< 0.001) in the HDR2 trial. The analysis with different risk factors and copula models revealed similarly high correlations, confirming a strong relation between PFS and OS in relapsed HL patients. Conclusions: PFS and OS as well as treatment effects and prognostic effects on PFS and OS are highly correlated in patients treated for relapsed HL. Confirming results in first-line treatment, PFS thereby constitutes a highly relevant endpoint also in the setting of relapsed HL.

The dark side of light at night: assessing breast cancer risk with a dose-response meta-analysis

Abstract Light at night (LAN) is a ubiquitous environmental issue resulting from exposure to artificial light during the night-time hours. The adverse effects of LAN include circadian disruption, melatonin suppression and altered clock gene expression. Very recent evidence suggests that LAN may increase risk of several diseases, including cancer. Breast cancer is the most common diagnosed cancer globally and the second leading cause of cancer-related mortality. Several environmental and life-style related risk factors have been linked to breast cancer onset. In this updated meta-analysis, we investigated how exposure to LAN may affect breast cancer risk. Using systematic online database searches (PubMed, Scopus, and Web of Science), we included 19 eligible studies (10 cohort and 9 case-control) investigating the association between LAN, either outdoor or indoor, and breast cancer risk. We first performed a meta-analysis comparing the highest versus lowest levels of exposure. Then, we performed a dose-response meta-analysis to investigate the shape of such relation. Overall, we found a positive association between LAN and breast cancer (risk ratio [RR] 1.08, 95% confidence interval-CI 1.03-1.13). In stratified analyses, the risk was more pronounced in premenopausal (RR 1.15, 95% CI 1.05-1.26) and normal-weighted (RR 1.17, 95% CI 1.00-1.36) women, while stratifying for outdoor/indoor exposure and for estrogen receptor status did not gave substantial differences in the risk estimates. The dose-response relation showed a linear risk increase up to 60 nW/cm2/sr after which the curve reached a plateau, especially among premenopausal women. These results strengthen the hypothesis that LAN is associated with breast cancer risk. Public health measures are warranted to minimize LAN exposure and reduce its related adverse effects on human health. Key messages • Light at night is positively associated with breast cancer risk. • The dose–response relation between light at night and breast cancer supports a positive association particularly in premenopausal women.

Diet Quality and Consumption of Healthy and Unhealthy Foods Measured via the Global Diet Quality Score in Relation to Cardiometabolic Outcomes in Apparently Healthy Adults from the Mediterranean Region: The ATTICA Epidemiological Cohort Study (2002-2022).

The Global Diet Quality Score (GDQS) is a novel food-based score that assesses both nutrient adequacy and chronic disease risk, by evaluating healthy (GDQS+) and unhealthy foods (GDQS-). The aim of this study was to evaluate the association among GDQS, GDQS+, and GDQS- against the 20-year risk of cardiometabolic outcomes in a Mediterranean population. The sample was n = 2169 initially free of cardiovascular disease (CVD) participants of the ATTICA study (2002-2022) that participated in the 20-year follow-up. The incidence of CVD, hypertension, hypercholesterolemia, and type 2 diabetes mellitus (T2DM) was defined according to WHO-ICD-10 criteria. The GDQS was computed based on previously published instructions. In multivariate analyses, a higher diet quality, per 1/49 of the GDQS, was associated with an 8% [95% Confidence Interval-CI: 6-9%] and 2% [95% CI: 1-3%] lower CVD and T2DM risk, respectively. A higher consumption of healthy foods, per 1/32 of GDQS+, was associated with a 9% [95% CI: 7-11%] and 2% [95% CI: 1-3%] lower CVD and T2DM risk, respectively. Contrarily, a lower consumption of unhealthy foods (GDQS-) was not associated with cardiometabolic events in the adjusted models (all p value< 0.05). In clinical practice or future public health actions to ameliorate dietary habits and prevent CVD and T2DM, more attention should be focused on healthy foods that should be included in our diets.

Inflammatory biomarkers link perceived stress with metabolic dysregulation

ObjectivePerceived stress has been identified as a risk factor for metabolic syndrome. However, the intermediate pathways underlying this relationship are not well understood. Inflammatory responses may be one process by which stress leads to metabolic dysregulation. Prior work has shown that chronic stress is associated with elevated systemic inflammation and that altered inflammatory activity contributes to the pathogenesis of metabolic syndrome. The current analyses tested this hypothesis by examining inflammation as a pathway by which perceived stress affects metabolic health. MethodsData from the Midlife in the United States Study (MIDUS) (N = 648; Mean age = 52.3) provided measures of perceived stress, inflammatory biomarkers [C-reactive protein (CRP), interleukin-6 (IL-6), E-selectin, fibrinogen, intracellular adhesion molecule-1 (ICAM-1)] and metabolic health markers. Confirmatory factor analysis (CFA) was used to confirm the fit of a hierarchical model of metabolic syndrome in our sample. Structural equation modeling (SEM) was used to test the assumption that inflammation mediates the association between perceived stress and the latent factor representing metabolic syndrome. ResultsThe CFA of metabolic syndrome demonstrated excellent goodness of fit to our sample [CFI = 0.97, TLI = 0.95, RMSEA = 0.06, SMSR = 0.05]. Mediation analysis with SEM revealed that the indirect pathway linking stress to metabolic dysregulation through inflammation was significant [B = 0.08, SE = 0.01, z = 3.69, p < .001, 95% confidence interval CI (0.04, 0.13)]. ConclusionsThese results suggest that inflammatory biomarkers are a viable explanatory pathway for the relationship between perceived stress and metabolic health consequences. Interventions that target psychosocial stress may serve as cost-effective and accessible treatment options for mitigating inflammatory health risks.

Causal effect of atrial fibrillation on pulmonary embolism: a mendelian randomization study.

Atrial fibrillation (AF) can increase thrombosis, especially arterial thrombosis, and some studies show that AF patients have a higher risk of developing pulmonary embolism (PE). The objective of our study is to investigate whether there is a direct causal effect of AF on PE. A two-sample Mendelian randomization (MR) approach was utilized to determine whether there is a causal relationship between AF and PE. European population-based consortia provided statistical data on the associations between Single Nucleotide Polymorphisms (SNPs) and relevant traits. The AF dataset was obtained from genome-wide association studies (GWAS) comprising 60,620 cases and 970,216 controls, while a GWAS of 1846 cases and 461,164 controls identified genetic variations associated with PE. Estimation of the causal effect was mainly performed using the random effects inverse-variance weighted method (IVW). Additionally, other tests such as MR-Egger intercept, MR-PRESSO, Cochran's Q test, "Leave-one-out," and funnel plots were conducted to assess the extent of pleiotropy and heterogeneity. Using 70 SNPs, there was no evidence to suggest an association between genetically predicted AF and risk of PE with multiplicative random-effects IVW MR analysis (odds ratio = 1.0003, 95% confidence interval: 0.9998-1.0008, P = 0.20). A null association was also observed in other methods. MR-Egger regression and MR-PRESSO respectively showed no evidence of directional (intercept, - 2.25; P = 0.94) and horizontal(P-value in the global heterogeneity test = 0.99) pleiotropic effect across the genetic variants. No substantial evidence was found to support the causal role of AF in the development of PE.

Treatment-seeking behaviours of malaria patients versus non-malaria febrile patients along China-Myanmar border

BackgroundAppropriate malaria treatment-seeking behaviour (TSB) is critical for timely detecting malaria, prompt treatment, and prevention of onward transmission of the disease in a community. This study aimed to compare treatment-seeking behaviours between malaria patients and non-malaria febrile patients, and to analyse the factors associated with appropriate TSB along the China-Myanmar border.MethodsA cross-sectional study was carried out to investigate the appropriate TSB of microscopy-confirmed malaria patients versus non-malaria febrile (NMF) patients. An unconditional logistic regression analysis (LRA) was used to identify factors associated with appropriate TSB.ResultsAmong 223 malaria patients and 446 NMF patients, 129 (57.8%) of the malaria patients versus 163 (36.5%) of the NMF patients firstly sought treatment in health facilities without laboratory testing for malaria (P < 0.0001). A total of 85(38.1%) of the malaria patients versus 278 (62.3%) of the NMF patients had appropriate TSB, namely, seeking treatment in health facilities with laboratory testing for malaria within 48 h (P < 0.0001). Multivariate LRA identified that the malaria patients with Chinese nationality had less appropriate TSB compared to those with other nationalities (adjusted odds ratio [AOR]: 0.21, 95% confidence interval CI 0.07–0.68, P = 0.0097), and malaria patients residing in urban areas had more appropriate TSB compared to those living in rural areas (AOR: 2.16, 95%CI 1.06–4.39, P = 0.0337).ConclusionsTSB was not appropriate in malaria patients. Chinese citizenship and rural residence were two independent factors associated with inappropriate malaria TSB. It is urgently necessary to improve appropriate malaria TSB through effective campaigns of information, education, and communication for malaria control in Myanmar and preventing reestablishment of malaria transmission in Yunnan, China.

Association between remnant cholesterol, metabolic syndrome, and cardiovascular disease: post hoc analysis of a prospective national cohort study

BackgroundEpidemiologic evidence suggested that remnant cholesterol (RC) is associated with the occurrence of cardiovascular disease (CVD). In recent years, RC has been connected with different types of cardiometabolic disorders. We aim to clarify the relationship among RC, metabolic syndrome (MetS) and subsequent CVD.MethodsWe enrolled 7471 individuals into our study from China Health and Nutrition Survey in 2009 and followed participants till 2015. RC was calculated as total cholesterol minus low-density lipoprotein cholesterol minus high-density lipoprotein cholesterol. CVD was defined as myocardial infarction and stroke. Multivariate logistic regression and Cox regression models were used to evaluate the association between RC and MetS as well as CVD. We further investigated whether the association between RC and CVD was mediated by MetS.ResultsOf all subjects, 24.73% were diagnosed with MetS and 2.74% developed CVD. Multivariate logistic regression analysis elucidated that per-tertile-increase in RC was associated with MetS after adjusting all the confounder factors, (odds ratio: 3.49, 95% confidence interval CI 3.21–3.79, P for trend < 0.001). And per-tertile-increase RC had a significant increased risk of CVD (hazard ratio: 1.26, 95% CI 1.06–1.50, P for trend = 0.008). Meanwhile, we found that RC level is associated with the prevalence of all the components of MetS. Significant indirect effects of RC between MetS and CVD were found, with the index mediated at 48.46% of the association.ConclusionsOur study provides the evidence that RC level is independently associated with the prevalence of MetS and each component of MetS. MetS partially mediated the association between RC level and CVD risk.

The origin of vitamin B12 levels and risk of all-cause, cardiovascular and cancer specific mortality: A systematic review and dose-response meta-analysis

BackgroundVitamin B12 is essential to human but the implications of serum vitamin B12 level for mortality in clinical practice remain unclear. We conducted a systematic review and dose-response meta-analysis to quantify the relationship between vitamin B12 levels and the risk of all-cause, cardiovascular, and cancer mortality. MethodsElectronic databases of PubMed, Embase, and the Cochrane Library Central Register of Controlled Trials were searched from inception through May 2023. Two reviewers independently extracted individual study data and evaluated the risk of bias among the studies using the Newcastle‒Ottawa Scale. To examine a potential nonlinear relationship between the vitamin B12 levels and all-cause mortality, we performed a two-stage random effects dose‒response meta-analysis. ResultsTwenty-two cohort studies (92,346 individuals with 10,704 all-cause deaths) were included. A linear trend dose-response analysis showed that each 100 pmol/L increase in serum vitamin B12 concentration was associated with a 4 % higher risk of all-cause mortality in the general population (adjusted HR 1.04, 95 % confidence interval CI 1.01 to 1.08; n = 8; P non-linearity = 0.11) and a 6 % higher risk for all-cause mortality in older adults (adjusted HR 1.06, 95 % CI 1.01 to 1.13; n = 4; P non-linearity = 0.78). Current evidence was mixed for the association between serum vitamin B12 concentration and cardiovascular mortality and was limited for cancer mortality. The meta-analysis of cohort studies showed a positive association between a high serum vitamin B12 concentration (>600 pmol/L) and all-cause mortality (adjusted HR 1.50, 95 % CI 1.29 to 1.74; n = 10; p < 0.01), CVD mortality (adjusted HR 2.04, 95 % CI 0.99 to 4.19; n = 2; p = 0.02), except cancer mortality (adjusted HR 1.56, 95 % CI 0.82 to 2.95; n = 3). Similarly, serum vitamin B12 concentrations (400–600 pmol/L) were associated with increased all-cause mortality (adjusted HR 1.34, 95 % CI 1.10 to 1.64; n = 9; p < 0.01). ConclusionsSerum vitamin B12 concentration was positively associated with the risk of all-cause mortality, especially among older adults, with a linear increasing trend. These findings suggested the primary cause of elevated level of serum vitamin B12 concentration should be timely identified and effectively managed in clinical practice.

Pediatric adrenocortical carcinoma: clinical features and application of neoadjuvant chemotherapy

ObjectiveTo summarize the clinical characteristics of children with adrenocortical carcinoma (ACC) and preliminarily explore the indications for and efficacy of neoadjuvant chemotherapy in certain patients.MethodsThe data of 49 children with adrenocortical tumors (ACT) in the past 15 years were retrospectively analyzed, and after pathology assessment using Weiss system grading, 40 children diagnosed with ACC were included. Response Evaluation Criteria in Solid Tumors (RECIST) 1.1 and three-dimensional (3D) reconstruction of contrast-enhanced computed tomography data were used to evaluate the response to neoadjuvant chemotherapy.ResultsForty patients (17 males, 23 females) with ACC were enrolled. Abnormal hormone levels were common in children with ACC (n = 31), and in terms of clinical presentation, sexual precocity was the most common (n = 14, 35.0%), followed by Cushing’s syndrome (n = 12, 30.0%). Seven of 40 children received neoadjuvant chemotherapy due to a maximum lesion diameter greater than 10 cm (n = 4), invasion of surrounding tissues (n = 2), intravenous tumor thrombus (n = 2), and/or distant metastasis (n = 2); 2 patients achieved partial response, and 5 had stable disease according to the RECIST 1.1 standard. Furthermore, 3D tumor volume reconstruction was performed in 5 children before and after neoadjuvant chemotherapy. Tumor volumes were significantly reduced in all 5 children, with a median volume reduction of 270 (interquartile range, IQR 83, 293) (range: 49–413) ml. After surgery with/without chemotherapy, the 5-year overall survival rate for all children was 90.0% (95% CI-confidence interval 80.0–100.0%), and the 5-year event-free survival rate was 81.5% (95% CI 68.0–97.7%).ConclusionIn the diagnosis and treatment of pediatric ACC, a comprehensive endocrine evaluation is necessary to facilitate early diagnosis. Surgery and chemotherapy are important components of ACC treatment, and neoadjuvant chemotherapy should be considered for children with ACC who meet certain criteria, such as a large tumor, distant metastases, or poor general condition.

Genetic Variations in the Purinergic P2X7 Receptor Are Associated with the Immune Response to Ocular Toxoplasmosis in Colombia.

Ocular toxoplasmosis (OT) is characterized by inflammation within the eye and is the most recognized clinical manifestation of toxoplasmosis. The objective of this study was to identify new single-nucleotide polymorphisms (SNPs) in the P2RX7 gene that may have significance in the immune response to OT in Colombian patients. A case-control study was conducted to investigate the associations between SNPs (rs1718119 and rs2230912) in the P2RX7 gene and OT in 64 Colombian patients with OT and 64 controls. Capillary electrophoresis was used to analyze the amplification products, and in silico algorithms were employed to predict deleterious SNPs. Stability analysis of amino acid changes indicated that both mutations could lead to decreased protein structure stability. A nonsynonymous SNP, Gln460Arg, located in the long cytoplasmic tail of the receptor, showed a significant association with OT (Bonferroni correction (BONF) = 0.029; odds ratio OR = 3.46; confidence interval CI: 1.05 to 11.39), while no significant association between rs1718119 and OT risk was observed. Based on the 3D structure analysis of the P2RX7 protein trimer, it is hypothesized that an increase in the flexibility of the cytoplasmic domain of this receptor could alter its function. This SNP could potentially serve as a biomarker for identifying Colombian patients at risk of OT.

POST-COVID-19-syndrome in young healthy women: myth or reality?

Aim. To assess the incidence and severity of new persistent symptoms in somatically healthy young women with and without a history of COVID-19.&#x0D; Materials and methods. The main study group included patients who had PCR-confirmed COVID-19 in JulyOctober 2021 (n=181); the comparison group included women without COVID-19 during this period (n=71). Inclusion criteria: female sex, age 1835 years, no pregnancy, overweight/obesity, diabetes mellitus, chronic hypertension, premenstrual syndrome, and other somatic and/or chronic infectious diseases. Post-COVID syndrome (PCS) was diagnosed based on symptoms absent before COVID-19, appeared 4 weeks from the disease onset, and lasted at least 2 months, which could not be explained by alternative diagnoses. We used primary medical records and interviewed patients using a special questionnaire to develop a statistical database. The severity of symptoms was assessed using a 10-point scale.&#x0D; Results. New persistent symptoms during the pandemic in young, initially somatically healthy women with and without COVID-19 were reported with similar frequency: 96.1 and 93.0%, respectively (odds ratio OR 1.88, 95% confidence interval CI 0.586.14; p2=0.327). Only patients with COVID-19 reported cough (43.6%), shortness of breath (26.5%), chest pain (18.2%), weight loss (18.8%), hair loss (60.8%); in the comparison group, these symptoms were not reported; p20.001. Patients with PCS were more likely to experience memory impairment 49.2% vs 12.7% (OR 6.66, 95% CI 3.1314.21; p20.001); headache 43.1% vs 11.3% (OR 5.96, 95% CI 2.713.17; p20.001); depression 19.9% vs 8.5% (OR 2.69, 95% CI 1.086.7; p2=0.029); myalgia 31.5% vs 8.5% (OR 4.98, 95% CI 2.0412.17; p20.001). Patients of both groups showed similar frequency of fatigue (69.0% vs 71.8%; p2=0.66), drowsiness (54.9% vs 43.6%; p2=0.11), palpitations (19.7% vs 29.8%; p2=0.1), menstrual cycle changes (22.5% vs 21.0%; p2=0.865), and skin manifestations (2.8% vs 6.6%; p2=0.24). COVID-19 survivors had a more pronounced memory impairment (4.0 vs 1.0 points; p0.001), headache (5.0 vs 3.0 points; p=0.001), myalgia (5.0 vs 1.0 points; p0.001) and less severe insomnia (3.0 vs 5.0 points; p=0.004).&#x0D; Conclusion. The PCS symptoms are common in initially somatically healthy women of early reproductive age. Similar symptoms in women with no history of COVID-19 may be due to post-traumatic stress anxiety disorder. Further interdisciplinary research is needed to identify the pathophysiological mechanisms for the occurrence of new persistent symptoms in different age and social groups during the COVID-19 pandemic.

Hair concentrations of selenium in the Moldovan population

BACKGROUND: There is a substantial body of evidence indicating that the ecosystems in the Republic of Moldova contain a significant amount of selenium. However, little is known regarding the levels of this essential element in the hair of the country's population.&#x0D; AIM: To assess hair concentrations of selenium in the population of the Republic of Moldova.&#x0D; METHODS: A cross-sectional study. Hair samples were collected from 301 participants aged 194 years. The data were presented and analyzed by gender and across the following age-groups: under 18, 1844, 4559 and 60+ years old. Determination of hair selenium concentration was carried out by fluorimetric method using Fluorat 02-5M fluorimeter (Lumex, Russia). Hair sample GBW 09101b was used as a reference standard. The statistical software package SPSS 23.0 was used for data processing. Normal distribution of the continuous variables was tested using KolmogorovSmirnov tests with Lilliefors significance correction. MannWhitney tests were used for comparing selenium concentrations while Kruska-Wallis tests were used for selenium concentrations across age-groups.&#x0D; RESULTS: Selenium concentrations in the hair of the population of Moldova ranged between 148 and 5000 g/kg with arithmetic mean (М)=697 g/kg, 95% confidence interval CI: 636758 g/kg, standard deviation (SD)=538 g/kg, geometric mean (G)=598 g/kg, median (Me)=584 g/kg. The average values of selenium concentration in the hair of the women (M=659 g/kg, G=565 g/kg) were significantly lower than those among the men (M=769 g/kg, G=666 g/kg), p=0.004. Geometric means of selenium concentrations increased with age (540585601741 g/kg), p = 0.026.&#x0D; CONCLUSION: This is the first study providing the evidence on hair concentration of selenium among the residents of Moldova. The results are congruent with earlier findings from the neighboring Odesa region of Ukraine with similar biogeochemical conditions. Significant gender differences in the concentration of selenium were observed. Moreover, hair concentration of selenium increased with age.