Consecutive Examinations Research Articles

Association of cumulative non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio with the risk of cardiometabolic disease.

One measurement of non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio (NHHR) is considered to be associated with insulin resistance and cardiovascular disease (CVD) risk. This study aimed to exploring the association between cumulative non-high-density lipoprotein cholesterol/high-density lipoprotein cholesterol (Cum NHHR) exposure levels and the risk of cardiometabolic disease (CMD). This prospective cohort study included 43,735 participants, who participated in three consecutive health examinations in 2006, 2008, 2010 and had no history of CMD or cancer. The participants were divided into quartiles bases on their cum NHHR. Multivariate Cox proportional hazards model was used to assess the association between cum NHHR and the risk of CMD. Additionally, the direct method of standardized ratios was employed to calculate the absolute risk of CMD attributable to cum NHHR. Over a median follow-up period of 10.92 years (IQR: 10.22-11.26 years), 7,388 participants were newly diagnosed with CMD. In the multivariate-adjusted model, participants in quartiles Q2, Q3 and Q4 showed a progressively increased relative risk of CMD compared to those in Q1, The fully adjusted hazard ratios (95% confidence intervals) for the risk of CMD in the Q2, Q3, and Q4 groups were 1.11 (1.04-1.20), 1.23 (1.14-1.32), and 1.29 (1.20-1.38), respectively, compared with the Q1 group. This association remained significant even after further adjustment for single measurements of NHHR. Moreover, cum NHHR was positively correlated with the absolute risk of CMD, cardiovascular diseases (CVD), and type 2 diabetes (T2DM). Higher cum NHHR is significantly associated with an increased risk of CMD, independent of single-point NHHR level. Additionally, there are significant different strengths of correlations between cum NHHR and different diseases.

Abstract 4113188: Increased Physical Activity Intensity Associated with Reduced Risk of Atrial Fibrillation among Older Adults in South Korea: A Retrospective Cohort Study

Introduction: Physical activity (PA) may be associated with a lower risk of atrial fibrillation (AF), but this relationship remains controversial. In particular, further research is needed on the association between changes in PA intensity and AF risk among older adults. Hypothesis: We hypothesized that an increase in PA intensity would be associated with a reduced risk of AF among older adults aged 65 years and older in South Korea. Aim: This cohort study aimed to evaluate the association between changes in metabolic equivalent tasks (METs)-min/week and the risk of AF in the elderly using a nationally representative database. Methods: We conducted a retrospective cohort study using the Korea National Health Insurance Service (KNHIS) database. This cohort included 1,726,697 individuals aged 65 years and older without a history of cardiovascular disease diagnosis who underwent two consecutive health screening examinations from 2009 to 2012. PA was defined as MET-min/week derived from two consecutive health examinations during 2009-2010 (1st period) and 2011-2012 (2nd period), respectively. The primary outcome was an AF diagnosis during the follow-up period from 2013 to 2021. We estimated the sub-distribution hazard ratio (sHR) and 95% confidence interval (CI) for the association of changes in PA intensity with AF using Fine-Gray sub-distribution hazard models after adjustment for covariates. Results: This study included 1,726,697 participants (mean age 71.08; 46.78% male). An increase in PA intensity was associated with a reduced risk of AF (P for trend<0.001). Compared to persisting in physical inactivity, a change in PA intensity from physically inactive to ≥1000 MET–min/week was associated with a lower risk of AF (sHR, 0.83, 95% CI, 0.81-0.85). In contrast, a change in PA intensity from ≥1000 MET–min/week to being physically inactive was associated with a higher risk of AF (sHR, 1.30, 95% CI, 1.27-1.33) as compared to persistence in ≥1000 MET–min/week of PA intensity. Conclusions: An increase in MET-min/week may be associated with a reduced risk of AF among adults aged 65 years and older. Therefore, interventions encouraging PA should be recommended to maximize the health benefits of AF prevention in the elderly.

Persistent proteinuria is associated with the occurrence of cardiovascular disease: a nationwide population-based cohort study

Proteinuria is an important risk factor for cardiovascular disease (CVD) and acts as a surrogate marker of renal damage. This study aimed to determine the association between changes in proteinuria and the occurrence of CVD. In our study, 1,708,712 participants who consecutively underwent national health examinations from 2003−2004 (first period) to 2005−2006 (second period) were included. They were classified into four groups based on the presence of proteinuria at the two consecutive health examinations: (1) normal (0 → 0), (2) proteinuria-improved (participants who had improved proteinuria (+ 1 → 0, + 2 → ≤ +1 [0 or + 1], ≥ +3 → ≤ +2 [0, + 1 or + 2]), (3) proteinuria-progressed (0 → ≥ +1, + 1 → ≥ +2, + 2 → ≥ +3), and (4) proteinuria-persistent (+ 1 → +1, + 2 → +2, ≥ +3 → ≥ +3). We used a multivariate Cox proportional hazards model to assess the occurrence of CVD according to changes of presence and severity of proteinuria. During a median of 14.2 years of follow-up, 143,041 participants (event rate, 8.37%) with composite CVD were observed. Compared with the normal group, the risk of incident risk of CVD was increased according to the severity of proteinuria in each of the persistent, progressed, and improved groups (p for trend < 0.001). In a pairwise comparison, the risk of composite CVD in the improved (hazard ratio [HR]: 1.32, 95% confidence interval [CI]: 1.27–1.37), progressed (HR: 1.49, 95% CI: 1.44–1.54), and persistent groups (HR: 1.78, 95% CI: 1.64–1.94) were higher than that of the normal group. Furthermore, the improved group had a relatively lower risk of composite CVD compared to the persistent group (HR: 0.75, 95% CI: 0.69–0.83, p < 0.001). The incidence risk of composite CVD was associated with changes of presence and severity of proteinuria. Persistent proteinuria may be associated with increased risk of CVD, even compared with improved or progressed proteinuria status.

Association of childhood obesity or weight change with early-onset follicular occlusion triad among children.

The effects of childhood obesity or weight gain on the development of early-onset follicular occlusion triad (FOT) among children, which includes hidradenitis suppurativa (HS), acne conglobata (AC), and dissecting cellulitis of the scalp (DCS), remain unknown. To investigate the association between body mass index (BMI) or its changes and early-onset FOT development. This nationwide population-based longitudinal cohort study included a cohort of 2,012,928 Korean children who underwent two consecutive health examinations at 30-36 months and 42-48 months of age between 2009 and 2020. The BMI and its changes derived during health screenings at 30-36 and 42-48 months. We performed multivariate Cox proportional hazards regression analyses to estimate the risk of early-onset FOT, including HS, AC, and DCS. During the follow-up, 1,283 FOT, including 143 HS, 1,068 AC, and 72 DCS, events were identified. Children with obesity were at an elevated risk of early-onset FOT compared to those with a normal weight (FOT: adjusted hazard ratio [aHR] 1.49, 95% confidence interval [CI] 1.21-1.84; HS: aHR 2.30, 95% CI 1.39-3.82; AC: aHR 1.36, 95% CI 1.07-1.73). BMI gain was correlated with an elevated risk of early-onset FOT, particularly HS, whereas BMI loss was linked to a decreased risk of early-onset FOT, especially HS. Children who became obese had an increased early-onset FOT risk (aHR 1.51, 95% CI 1.07-2.14) compared to those who maintained a normal weight. Children who reduced from obese to normal weight exhibited a decreased risk of early-onset FOT (FOT: aHR 0.41, 95% CI 0.17-0.96, P for trend=0.02; HS: P for trend=0.05) compared to obese children who retained their weight. Childhood obesity was associated with an elevated risk of early-onset FOT, including HS and AC. Weight gain was correlated with an increased risk of early-onset FOT, especially HS, while weight loss was associated with a decreased risk of early-onset FOT, particularly HS. Implementing purposeful weight-reduction strategies may be helpful in preventing early-onset FOT development.

Artificial Intelligence Algorithm for Subclinical Breast Cancer Detection

Early breast cancer detection is associated with lower morbidity and mortality. To examine whether a commercial artificial intelligence (AI) algorithm for breast cancer detection could estimate the development of future cancer. This retrospective cohort study of 116 495 women aged 50 to 69 years with no prior history of breast cancer before they underwent at least 3 consecutive biennial screening examinations used scores from an AI algorithm (INSIGHT MMG, version 1.1.7.2; Lunit Inc; used September 28, 2022, to April 5, 2023) for breast cancer detection and screening data from multiple, consecutive rounds of mammography performed from September 13, 2004, to December 21, 2018, at 9 breast centers in Norway. The statistical analyses were performed from September 2023 to August 2024. Artificial intelligence algorithm score indicating suspicion for the presence of breast cancer. The algorithm provided a continuous cancer detection score for each examination ranging from 0 to 100, with increasing values indicating a higher likelihood of cancer being present on the current mammogram. Maximum AI algorithm score for cancer detection and absolute difference in score among breasts of women developing screening-detected cancer, women with interval cancer, and women who screened negative. The mean (SD) age at the first study round was 58.5 (4.5) years for 1265 women with screening-detected cancer in the third round, 57.4 (4.6) years for 342 women with interval cancer after 3 negative screening rounds, and 56.4 (4.9) years for 116 495 women without breast cancer all 3 screening rounds. The mean (SD) absolute differences in AI scores among breasts of women developing screening-detected cancer were 21.3 (28.1) at the first study round, 30.7 (32.5) at the second study round, and 79.0 (28.9) at the third study round. The mean (SD) differences prior to interval cancer were 19.7 (27.0) at the first study round, 21.0 (27.7) at the second study round, and 34.0 (33.6) at the third study round. The mean (SD) differences among women who did not develop breast cancer were 9.9 (17.5) at the first study round, 9.6 (17.4) at the second study round, and 9.3 (17.3) at the third study round. Areas under the receiver operating characteristic curve for the absolute difference were 0.63 (95% CI, 0.61-0.65) at the first study round, 0.72 (95% CI, 0.71-0.74) at the second study round, and 0.96 (95% CI, 0.95-0.96) at the third study round for screening-detected cancer and 0.64 (95% CI, 0.61-0.67) at the first study round, 0.65 (95% CI, 0.62-0.68) at the second study round, and 0.77 (95% CI, 0.74-0.79) at the third study round for interval cancers. In this retrospective cohort study of women undergoing screening mammography, mean absolute AI scores were higher for breasts developing vs not developing cancer 4 to 6 years before their eventual detection. These findings suggest that commercial AI algorithms developed for breast cancer detection may identify women at high risk of a future breast cancer, offering a pathway for personalized screening approaches that can lead to earlier cancer diagnosis.

Diagnostic Accuracy of Screening Contrast-enhanced Mammography for Women with Extremely Dense Breasts at Increased Risk of Breast Cancer.

Background Mammogram interpretation is challenging in female patients with extremely dense breasts (Breast Imaging Reporting and Data System [BI-RADS] category D), who have a higher breast cancer risk. Contrast-enhanced mammography (CEM) has recently emerged as a potential alternative; however, data regarding CEM utility in this subpopulation are limited. Purpose To evaluate the diagnostic performance of CEM for breast cancer screening in female patients with extremely dense breasts. Materials and Methods This retrospective single-institution study included consecutive CEM examinations in asymptomatic female patients with extremely dense breasts performed from December 2012 to March 2022. From CEM examinations, low-energy (LE) images were the equivalent of a two-dimensional full-field digital mammogram. Recombined images highlighting areas of contrast enhancement were constructed using a postprocessing algorithm. The sensitivity and specificity of LE images and CEM images (ie, including both LE and recombined images) were calculated and compared using the McNemar test. Results This study included 1299 screening CEM examinations (609 female patients; mean age, 50 years ± 9 [SD]). Sixteen screen-detected cancers were diagnosed, and two interval cancers occured. Five cancers were depicted at LE imaging and an additional 11 cancers were depicted at CEM (incremental cancer detection rate, 8.7 cancers per 1000 examinations). CEM sensitivity was 88.9% (16 of 18; 95% CI: 65.3, 98.6), which was higher than the LE examination sensitivity of 27.8% (five of 18; 95% CI: 9.7, 53.5) (P = .003). However, there was decreased CEM specificity (88.9%; 1108 of 1246; 95% CI: 87.0, 90.6) compared with LE imaging (specificity, 96.2%; 1199 of 1246; 95% CI: 95.0, 97.2) (P < .001). Compared with specificity at baseline, CEM specificity at follow-up improved to 90.7% (705 of 777; 95% CI: 88.5, 92.7; P = .01). Conclusion Compared with LE imaging, CEM showed higher sensitivity but lower specificity in female patients with extremely dense breasts, although specificity improved at follow-up. © RSNA, 2024 See also the editorial by Lobbes in this issue.

Study on risk factors of impaired fasting glucose and development of a prediction model based on Extreme Gradient Boosting algorithm.

The aim of this study was to develop and validate a machine learning-based model to predict the development of impaired fasting glucose (IFG) in middle-aged and older elderly people over a 5-year period using data from a cohort study. This study was a retrospective cohort study. The study population was 1855 participants who underwent consecutive physical examinations at the First Affiliated Hospital of Soochow University between 2018 and 2022.The dataset included medical history, physical examination, and biochemical index test results. The cohort was randomly divided into a training dataset and a validation dataset in a ratio of 8:2. The machine learning algorithms used in this study include Extreme Gradient Boosting (XGBoost), Support Vector Machines (SVM), Naive Bayes, Decision Trees (DT), and traditional Logistic Regression (LR). Feature selection, parameter optimization, and model construction were performed in the training set, while the validation set was used to evaluate the predictive performance of the models. The performance of these models is evaluated by an area under the receiver operating characteristic (ROC) curves (AUC), calibration curves and decision curve analysis (DCA). To interpret the best-performing model, the Shapley Additive exPlanation (SHAP) Plots was used in this study. The training/validation dataset consists of 1,855 individuals from the First Affiliated Hospital of Soochow University, yielded significant variables following selection by the Boruta algorithm and logistic multivariate regression analysis. These significant variables included systolic blood pressure (SBP), fatty liver, waist circumference (WC) and serum creatinine (Scr). The XGBoost model outperformed the other models, demonstrating an AUC of 0.7391 in the validation set. The XGBoost model was composed of SBP, fatty liver, WC and Scr may assist doctors with the early identification of IFG in middle-aged and elderly people.

Digital Breast Tomosynthesis Screening Improves Early Breast Cancer Detection and Survival in Taiwan.

Our objective was to compare the efficacy of digital breast tomosynthesis (DBT) and digital mammography (DM) in breast cancer screening and their impact on long-term overall survival (OS). The study involved 48 549 consecutive mammography examinations between 2011 and 2015 at a medical center in Taiwan, identifying 545 women who were screened and diagnosed with breast cancer. Digital mammography and DBT examinations were alternated on different days. Patients were categorized based on mammographic modality, breast density, and American Joint Committee on Cancer (AJCC) stage. To determine the long-term outcome until August 2021, survival rates were analyzed using the Kaplan-Meier (K-M) survival analysis. The mean age at breast cancer diagnosis was 53.2 years. Digital breast tomosynthesis examinations were significantly associated with early breast cancer (AJCC stage 0 to 2) (P = .022). The 5- and 9-year OS rates for all patients were 96.8% and 93.0%, respectively. The 5- and 9-year OS was significantly greater in the DBT group (98.4% and 96.8%) compared with the DM group (95.0% and 90.4%) (P = .030 for all). The K-M survival analysis demonstrated a significantly higher OS in the DBT group than the DM group (P = .037). Furthermore, DBT significantly improved OS in a cohort of women with stage II and III cancer (P = .032) and heterogeneously dense breasts (P = .045). Screening with DBT is associated with early breast cancer diagnosis and higher survival rates compared with DM.

Quality assessment of expedited AI generated reformatted images for ED acquired CT abdomen and pelvis imaging.

Retrospectively compare image quality, radiologist diagnostic confidence, and time for images to reach PACS for contrast enhanced abdominopelvic CT examinations created on the scanner console by technologists versus those generated automatically by thin-client artificial intelligence (AI) mechanisms. A retrospective PACS search identified adults who underwent an emergency department contrast-enhanced abdominopelvic CT in 07/2022 (Console Cohort) and 07/2023 (Server Cohort). Coronal and sagittal multiplanar reformatted images (MPR) were created by AI software in the Server cohort. Time to completion of MPR images was compared using 2-sample t-tests for all patients in both cohorts. Two radiologists qualitatively assessed image quality and diagnostic confidence on 5-point Likert scales for 50 consecutive examinations from each cohort. Additionally, they assessed for acute abdominopelvic findings. Continuous variables and qualitative scores were compared with the Mann-Whitney U test. A p < .05 indicated statistical significance. Mean[SD] time to exam completion in PACS was 8.7[11.1] minutes in the Console cohort (n = 728) and 4.6[6.6] minutes in the Server cohort (n = 892), p < .001. 50 examinations in the Console Cohort (28 women 22 men, 51[19] years) and Server cohort (27 women 23 men, 57[19] years) were included for radiologist review. Age, sex, CTDlvol, and DLP were not statistically different between the cohorts (all p > .05). There was no significant difference in image quality or diagnostic confidence for either reader when comparing the Console and Server cohorts (all p > .05). Examinations utilizing AI generated MPRs on a thin-client architecture were completed approximately 50% faster than those utilizing reconstructions generated at the console with no statistical difference in diagnostic confidence or image quality.

ThP8.7 - Giant Cell Arteries: Diagnostics

Abstract Aim Giant cell arteritis (GCA) poses a risk of severe ischaemic complications such as irreversible blindness which mandates early recognition of condition. We aimed to evaluate effectiveness of ultrasound doppler (USD) in diagnosing GCA compared to temporal artery biopsy (TAB) and American College of Rheumatology (ACR) score. Method This retrospective study included patients with suspected GCA who had consecutive TAB and USD examinations performed over a course of three years (2017-2022) which was correlated with ACR score. The data was also analysed to assess further management. Results There were 64 patients over this period who had both studies performed (22 were excluded as they did not have TAB) with 64% having an ACR score ≥3. Twenty males and forty-four females with a median age of 77 years (IQR 84-67). Overall, 81% patients had a negative USD result. Comparing USD results with TAB gold standard, there was sensitivity of 63% and specificity of 84%. Comparing USD results with ACR as gold standard, there was sensitivity of 20% and specificity of 83%. Forty percent patients with negative doppler result were continued on treatment mainly due to improvement of symptoms in response to steroids. Conclusion US Doppler has high diagnostic specificity and low sensitivity which makes it time-efficient, cost-effective and allows for the implementation of fast-track management pathway for majority patients. In certain circumstances, as cases of low clinical suspicion and positive doppler result, an additional test (TAB) would be required to confirm the diagnosis and cases where clinical suspicion is high with negative doppler, TAB should be considered.

ThP8.6 - A real-world diagnostic algorithm for identifying carotid artery stenosis

Abstract Aim Eighty-five percent of ischaemic strokes are caused by extracranial atheromatous lesions involving a narrowing of the Internal Carotid Artery so accurate and timely diagnosis is vital for management. The aim of this study was to correlate CT angiogram (CTA) and ultrasound doppler (US) derived measurements of carotid artery stenosis (CAS), with a view to identify those cases where second modality is required to reduce potential errors. Methods All consecutive carotid US and CTA examinations performed in 2021 and 2022 were included for comparison in this retrospective cohort study. Collected data was then reviewed and evaluated by a multidisciplinary team. North American Symptomatic Carotid Endarterectomy Trial (NASCET) and St Mary’s criteria were used to narrow down the percentage stenosis. Result There were fifty-one patients (102 carotid arteries) over this period who had both studies performed. Twenty-nine males and twenty-three females with a median age of seventy-three. Initial data analysis showed no discrepancy in ninety-one (90%) carotid arteries between both modalities. After MDT review, there were eight (7.1%) false positive results and three (2.9%) true positive (2 symptomatic &amp; 1 asymptomatic). In three (2.9%) cases quantification was significantly inaccurate in the initial imaging modality because of heavily calcified vessels. Conclusion This study supports the use of US or CTA as a single modality in grading CAS. Heavily calcified vessels on the first test should be a ‘red flag’ for triggering further alternative imaging to reduce the risk of error. Persistent discrepancies even after the second modality will require a further modality e.g. enhanced magnetic resonance angiography.

Impact of Slim Linear Echoendoscope on the Practice of EUS.

Standard linear echoendoscopes have a large distal tip and bending radius, which can preclude adequate examination in some patients. We examined the impact of having available slim linear echoendoscopes (SLE) on our endoscopic ultrasound (EUS) practice. As a quality improvement measure, data on the need for the use of SLE were documented in 2000 consecutive procedures performed over a 10-month period from February to November 2022. When examination using a standard size echoendoscope failed due to technical limitations, the procedure was reattempted in the same session using a SLE. The main outcome was the impact of SLE, which was defined as the establishment of a new diagnosis or if findings altered treatment plan. A complete EUS examination failed in 23 of 2000 procedures (1.15%, 95% CI, 0.73-1.72%) performed using standard size echoendoscope (14 male, median age 73y [IQR 66 to 79]). The examination was technically successful when using SLE in 22 of 23 (95.6%) patients. SLE impacted clinical management in all 22 patients (100%) by establishing tissue diagnosis in 19 and/or altering subsequent treatment plan in 5. Adverse event of transient hypoxia was observed in one patient (4.3%). A very experienced EUS team required SLE in 1.1% of consecutive examinations. Our findings suggest that when used, 95% of patients benefitted as it had a significant impact on their clinical management.

Persistence of power Doppler ultrasonography-detected synovitis over 1 year of follow-up predicts poor prognosis in rheumatoid arthritis in clinical remission: the SONORE prospective longitudinal study

Objectives(1) To assess the progression of ultrasonography-detected synovitis in a cohort of patients with rheumatoid arthritis (RA) in remission during 1 year of follow-up (2) to evaluate the ability of...

The Effect of Farm-Animal-Assisted Education on Memory Retention in Elementary School Children: An Exploratory Study

ABSTRACT Animal-assisted education (AAE) can provide an exciting and innovative alternative to conventional teaching methods. Numerous studies have been published on the influence of the participation of living animals (primarily dogs) in the educational process on students’ emotions. However, the impact of on-farm teaching on children’s academic knowledge has not received much attention. This study aimed to evaluate whether outdoor learning in the presence of farm animals during animal-oriented lessons impacts knowledge performance and memory retention. The experimental group (n = 71) attended a class at an eco-center farm and directly interacted with farm animals. In contrast, the control group (n = 78) received identical content in a classroom using conventional teaching aids. Knowledge in both groups was compared quantitatively with paper-and-pencil tests in three consecutive examinations: pre-, post-, and follow-up (28 days later). The intergroup results of the pre- and post-examinations showed no difference. However, a significant difference in the intergroup knowledge scores was observed at the one-month follow-up test. The pupils in the experimental group maintained significantly broader knowledge over time than their peers in the control group. These results suggest that implementing AAE into the education process might not affect pupils’ immediate knowledge performance, but it could positively impact memory retention. As scientific research on using farm animals in education is scarce, additional research is needed.

Smoking Cessation and Risk of Hidradenitis Suppurativa Development

Although tobacco smoking is established as a risk factor for hidradenitis suppurativa (HS), studies on the effects of smoking cessation on HS are limited, and evidence is lacking. To examine the association between changes in smoking status and the development of HS. This population-based cohort study enrolled participants from the Korean National Health Insurance Service database who had undergone 2 consecutive biennial health examinations (2004-2005 and 2006-2007) as the primary cohort. Within the primary cohort, the secondary cohort comprised individuals who underwent all biennial health examinations throughout the follow-up period and maintained the same smoking status from 2006 to 2007 to the end of the follow-up period. Data were analyzed from July to December 2023. Changes in smoking habit status. Risk of HS development. The HS risk according to change in smoking status between the 2 consecutive health examinations was estimated using a Cox proportional hazards model. Of the 6 230 189 participants enrolled, the mean (SD) age was 47.2 (13.5) years, and 55.6% were male. During 84 457 025 person-years of follow-up, 3761 HS events occurred. In the primary cohort, compared to those who consistently reported active smoking at both checkups (ie, sustained smokers), lower HS risk was seen among those who were confirmed to smoke initially but quit by the second checkup (ie, smoking quitters) (adjusted hazard ratio [AHR], 0.68; 95% CI, 0.56-0.83), those who maintained cessation status throughout (AHR, 0.67; 95% CI, 0.57-0.77), and those who reported never smoking at either checkup (ie, never smokers) (AHR, 0.57; 95% CI, 0.52-0.63). Those who initially quit smoking but resumed by the second checkup and those who had no previous smoking history but started at the second checkup (ie, new smokers) exhibited similar HS risk as sustained smokers. The secondary cohort results aligned with those of the primary cohort, showing a more pronounced risk reduction with smoking cessation (AHR, 0.57; 95% CI, 0.39-0.83). Considering time-smoking interaction, the cumulative incidence and the risk of HS in smoking quitters were similar to those in sustained smokers in the early stages of observation. However, 3 to 4 years after smoking cessation, the rate decelerated, resembling that of never smokers, and there was a statistically significant decrease in the risk that persisted (between 3 and 6 years from the index date: AHR, 0.58; 95% CI, 0.36-0.92; and ≥12 years from the index date: AHR, 0.70; 95% CI, 0.50-0.97). New smokers initially paralleled never smokers but accelerated after 2 to 3 years, reaching sustained smokers' levels. In this cohort study, quitting smoking and sustaining a smoke-free status were associated with a reduced risk of HS development compared to continuous smoking. In contrast, resuming or initiating smoking may have as detrimental an effect on HS development as continual smoking.

Characterisation of delayed severity flares in patients with HLA-B27-associated anterior uveitis

Background/aimsTo explore and characterise the clinical phenotype of acute anterior uveitis flares with delayed severity in patients with human leucocyte antigen B27 (HLA-B27)-associated anterior uveitis.MethodsRetrospective chart review of patients with...

The Accuracy of Artificial Intelligence ChatGPT in Oncology Examination Questions

The aim of this study is to assess the accuracy of Chat Generative Pretrained Transformer (ChatGPT) in response to oncology examination questions in the setting of one-shot learning. Consecutive national radiation oncology in-service multiple-choice examinations were collected and inputted into ChatGPT 4o and ChatGPT 3.5 to determine ChatGPT’s answers. ChatGPT’s answers were then compared with the answer keys to determine whether ChatGPT correctly or incorrectly answered each question and to determine if improvements in responses were seen with the newer ChatGPT version. A total of 600 consecutive questions were inputted into ChatGPT. ChatGPT 4o answered 72.2% questions correctly, whereas 3.5 answered 53.8% questions correctly. There was a significant difference in performance by question category (P < .01). ChatGPT performed poorer with respect to knowledge of landmark studies and treatment recommendations and planning. ChatGPT is a promising technology, with the latest version showing marked improvement. Although it still has limitations, with further evolution, it may be considered a reliable resource for medical training and decision making in the oncology space.

The GG genotype of rs743572 in CYP17A1 gene regulating the decrease of T/E ratio can be an independent risk factor for MetS-BPH: a retrospective cohort study

PurposeTo confirm if the CYP17A1 gene regulates the ratio of T/E leading to MetS-BPH.Methods824 men, aged 47–88 years, were recruited into this study through consecutive routine physical examination programs and long-term outpatient screening. Several parameters, including SNPs of CYP17A1 gene, total testosterone, estradiol, and the ratio of total testosterone to estradiol (T/E) were obtained for each participant. Based on the diagnosis of BPH, MetS, and MetS-BPH, the participants were divided into BPH and non-BPH groups, MetS and non-MetS groups, and MetS-BPH and non-MetS-BPH groups. Values of the obtained parameters were evaluated using one-way analysis of variance, Student’s t-test, Chi-squared test, and logistic regression analysis.ResultsSNPs of the CYP17A1 gene, including the rs743572 genotypes (GG, GA, and AA), rs3781287 genotypes (GG, GT, TT), and rs4919686 genotypes (CC, CA, and AA), were present in every group. Only the GG genotype of rs743572 was independently associated with BPH (OR = 5.868, 95% CI: 3.363–7.974, P < 0.001), MetS (OR = 7.228, 95% CI: 3.925–11.331, P < 0.001), and MetS-BPH (OR = 3.417, 95% CI: 1.783–5.266, P < 0.001) after adjusting for age. In the population of genotype GG of rs743572, the decrease in T/E ratio was an independent risk factor for BPH (OR = 839.756, 95% CI: 36.978-1334.263, P = 0.001), MetS (OR = 376.988, 95% CI: 12.980-488.976, P < 0.003), and MetS-BPH (OR = 388.236, 95% CI: 24.869-495.363, P = 0.003).ConclusionThe GG genotype of rs743572 in CYP17A1 gene regulating the decrease of T/E ratio can be an independent risk factor for MetS-BPH populations.Trial registration numberChiCTR2200057632 “retrospectively registered”.Date of registrationMarch 15, 2022 “retrospectively registered”.

Peroneus brevis split rupture is underreported on magnetic resonance imaging of the ankle in patients with chronic lateral ankle pain

IntroductionPeroneus brevis split rupture poses a diagnostic challenge, often requiring magnetic resonance imaging (MRI), yet splits are missed in initial radiological reports. However, the frequency of reported peroneus brevis split rupture in clinical MRI examinations is unknown. AimThis study aimed to investigate underreporting frequency of peroneus brevis split rupture in patients with lateral ankle pain. MethodsWe re-evaluated 143 consecutive MRI examinations of the ankle joint, conducted in 2021 in our region, for patients experiencing ankle pain persisting for more than 8 months. Two musculoskeletal radiologists, with 12 and 8 years of experience respectively, assessed the presence of peroneus brevis split rupture. Patients with recent ankle trauma, fractures, postoperative changes, or MRI artifacts were excluded. The radiologists evaluated each MRI for incomplete or complete peroneus brevis split rupture. The consensus between the raters was used as the reference standard. Additionally, raters reviewed the original clinical radiological reports to determine if the presence of peroneus brevis split rupture was noted. Agreement between raters' assessments, consensus, and initial reports was evaluated using Gwet’s AC1 coefficients. ResultsInitial radiological reports indicated 23 cases (52.3 %) of peroneus brevis split rupture, meaning 21 cases (47.7 %) were underreported. The Gwet’s AC1 coefficients showed that the agreement between raters and initial reports was 0.401 (standard error 0.070), 95 % CI (0.261, 0.541), p<.001, while the agreement between raters in the study was 0.716 (standard error 0.082), 95 % CI (0.551, 0.881), p<.001. ConclusionPeroneus brevis split rupture is underreported on MRI scans of patients with lateral ankle pain.

Approximation of Glomerular Filtration Rate after 1 Year Using Annual Medical Examination Data.

Background: This cohort study was conducted to devise an approximation formula for predicting the glomerular filtration rate (GFR) after 1 year using annual medical examination data from the general population. Methods: Consecutive annual medical examination data were obtained for 41,337 inhabitants. Machine learning with the random forest method was used to assess the importance of each clinical parameter in terms of its association with estimated GFR (eGFR) after 1 year. An approximation formula was developed by multiple linear regression analysis based on the four most important clinical parameters. The relationship between the GFR after 1 year approximated by our formula and the eGFR after 1 year was analyzed using Pearson's correlation coefficient. Results: The following approximation formula was obtained by multiple linear regression analysis: approximate GFR after 1 year (mL/min/1.73 m2) = -0.054 × age + 0.162 × hemoglobin - 0.085 × uric acid + 0.849 × eGFR + 11.5. The approximate GFR after 1 year was significantly and strongly correlated with the eGFR at that time (r = 0.884; p < 0.001). Conclusions: An approximation formula including age, hemoglobin, uric acid, and eGFR may be useful for predicting GFR after 1 year among members of the general population.