Cox Proportional Hazards Model Research Articles

Estimating power wheelchair electronics lifespan based on real-world data.

Electronics are crucial to the operation and utility of power wheelchairs (PWCs). Existing research falls short in understanding electronics lifespan, which should inform proper maintenance and funding. This study investigates the lifespan of PWC electronics, aiming to estimate time until repair or replacement and identify contributing factors to variability in lifespan. Retrospective data from 1268 group 2 PWCs, collected from the Wheelchair Repair Registry, were analysed using Kaplan-Meier's survival analysis and Cox proportional hazards models. Results indicate that 29.2% of PWCs experienced electronics-related repairs, with a median survival of 32.2 months. Significant predictors of reduced electronics survival included device type (group 3 hazard ratio (HR), 1.58; p = .003), distribution year in 2017 (HR, 1.82; p < .001) and distribution year in 2018 (HR, 4.08; p < .001). Manufacturer D was a marginally significant factor in reduced survival (HR, 1.66, p = .070). These findings underscore the importance of proper maintenance and design in enhancing PWC reliability and user quality of life. Future research should expand data inclusivity and consider broader implications for global PWC users.

Association between Life's Essential 8 and risk of heart failure: findings from the Kailuan study.

The impact of Life's Essential 8 (LE8) on heart failure (HF) remains poorly understood. We examined the associations between three forms of LE8 measurements and HF. A total of 35 896 participants without a prior history of HF from the Kailuan community were included. The LE8 status was measured in 2014. A latent mixture model was employed to identify the trajectories of LE8 during 2006 to 2014. The LE8 annual change rate was defined as the slope of the linear regression equation fitted by five LE8 measurements. Cox proportional hazards models were used to assess the risk of HF associated with LE8, after adjusting for potential confounding variables. The predictive performance was quantified and compared using the C-index. Five distinct LE8 trajectories were identified. 461 HF events documented during follow-up. The LE8 trajectories presenting an upward trend in LE8 were associated with a reduced risk of HF, even when the initial LE8 level was low [HR (95% confidence interval) for moderate-increasing vs. moderate-decreasing trajectory was 0.43 (0.34, 0.55)]. The LE8 status was inversely associated with HF risk. A higher LE8 annual increase was associated with a lower risk of HF. The LE8 trajectory was more accurate in predicting the risk of HF compared with LE8 status. LE8 was inversely associated with HF risk. Individuals with initially low LE8 levels experienced a reversal in HF risk upon improvement. Both LE8 trajectories and status are practicable in identifying individuals at high risk of HF, LE8 trajectories may provide added prognostic information.

Prognostic relevance of baseline exercise stress test in RYR2-related CPVT.

Exercise stress test (EST) represents the gold standard for diagnosis of catecholaminergic polymorphic ventricular tachycardia (CPVT). We aimed to determine the relevance of exercise induced VT for the occurrence of LAE at follow-up. In RYR2-related CPVT patients who underwent a baseline EST, we assessed the incidence and severity of ventricular arrhythmias (VA). Data were analysed using logistic regression models and Cox proportional hazards models. The primary outcome was the occurrence of life-threatening arrhythmic event (LAE; composite of sudden cardiac death, aborted cardiac arrest, or hemodynamically non-tolerated VT) at follow-up. In 102 RYR2-related CPVT patients (65 females; median age 16 years, IQR: 11-36 years), exercise-induced VT (bidirectional in 64% of cases) was elicited in 56% patients. VT could not be induced in pre-school children. Lower basal heart rate, early onset VA (within the first step of EST) and heart rate at the first minute of recovery were associated with exercise-induced VT. Cox analyses showed that early onset VA (HR 6.0, 95% CI: 1.3-27.9, P = 0.022) and exercise-induced VT (HR 6.6, 95% CI: 1.5-29.1, P = 0.012) at baseline EST were significantly associated with the occurrence of LAE at follow-up, and remained associated even after correction for symptoms. Early onset VA and exercise-induced VT at baseline EST was associated with LAE at follow-up, allowing to identify a sub-set of patients at higher risk already at diagnosis.

Treatment practices and survival outcomes for IDH-wildtype glioblastoma patients according to MGMT promoter methylation status: insights from the U.S. National Cancer Database.

Methylation of the O6-methylguanine-DNA methyltransferase (MGMT) promoter is an important prognostic marker in glioblastoma (GBM); however, its implementation in clinical practice remains understudied. Here, we assessed the prevalence of MGMT methylation status among GBM patients in the United States. Additionally, we evaluated treatment practices and survival outcomes of GBM patients according to MGMT promoter methylation status. The National Cancer Database was queried to identify all adult U.S. patients (≥ 18 years) diagnosed with IDH-wildtype GBM between 2018 and 2020. Treatment regimen was grouped into no chemotherapy and no radiotherapy, chemotherapy alone (without radiotherapy), radiotherapy alone (without chemotherapy), and chemoradiotherapy (chemotherapy and radiotherapy). Survival data were analyzed using Kaplan-Meier survival curves, log-rank tests, and multivariable Cox proportional hazard modeling. A total of 20,734 patients were included, of whom 6,404 (30.9%) had MGMT-methylated GBM, 9,065 (43.7%) had MGMT-unmethylated tumors, and 5,265 (25.4%) had unknown methylation status. The median and three-year overall survival were 12.4 months and 15.5%, respectively, for the entire cohort (16.4 months and 23.9% for MGMT-methylated patients and 11.8 months and 9.8% for MGMT-unmethylated patients, p < 0.001). Chemoradiotherapy was less commonly used for elderly (≥ 70 years, 58.5%) than non-elderly (< 70 years, 79.2%) patients. Among elderly patients, radiotherapy alone was more commonly administered than chemotherapy alone for patients with MGMT-unmethylated tumors (11.2% vs. 2.1%) and MGMT-methylated tumors (6.6% vs. 3.9%). However, chemotherapy alone was associated with a lower mortality risk (HR 0.71, 95% CI 0.51-0.99, p = 0.04) than radiotherapy alone for elderly patients with MGMT-methylated tumors, while chemotherapy alone was associated with a higher mortality risk (HR 1.63, 95% CI 1.09-2.44, p = 0.02) than radiotherapy alone for elderly patients with MGMT-unmethylated tumors. Patients who were elderly, uninsured, insured through Medicaid, lived in zip codes with lower median education levels, or received care at non-academic programs were less likely to undergo MGMT testing. A high proportion of GBM patients in the United States undergo MGMT promoter testing, though significant sociodemographic disparities exist. While there was a decrease in chemoradiotherapy use with increasing age, radiotherapy alone was more commonly administered to elderly patients than chemotherapy alone irrespective of MGMT promoter methylation status.

Post‐selection inference for the Cox model with interval‐censored data

AbstractWe develop a postselection inference method for the Cox proportional hazards model with interval‐censored data, which provides asymptotically valid p‐values and confidence intervals conditional on the model selected by lasso. The method is based on a pivotal quantity that is shown to converge to a uniform distribution under local parameters. Our method involves estimation of the efficient information matrix, for which several approaches are proposed with proof of their consistency. Thorough simulation studies show that our method has satisfactory performance in samples of modest sizes. The utility of the method is illustrated via an application to an Alzheimer's disease study.

Perioperative Anticholinergic Medication Use and Incident Dementia among Older Surgical Patients: a Retrospective Cohort Study using Real-World Data.

Inpatient anticholinergic medications have been associated with a higher likelihood of postoperative delirium in older adults. However, it remains unclear whether administering anticholinergic medications after surgery adversely affects long-term cognitive function. We aimed to evaluate the relationship between in-hospital anticholinergic medications and time to incident dementia in a cohort of older surgical patients. We also sought to determine whether the association between in-hospital anticholinergic drugs and dementia differed by sex and prehospital anticholinergic exposure. This was a retrospective analysis of electronic health record data from a regional health information exchange. The study population included patients aged 50 years and older who underwent major surgery requiring an inpatient stay between 2014 and 2021. Orders for anticholinergic medications were identified using the anticholinergic cognitive burden (ACB) scale. A Cox proportional hazards model was used to estimate the association between inpatient orders for strong anticholinergics and incident dementia after hospital discharge. Cause-specific hazards were modeled. Stratification and relative excess risk due to interaction (RERI) were used to investigate multiplicative and additive interaction, respectively. In total, 66,420 surgical encounters were analyzed. Approximately 90% of patients received one or more strong anticholinergics during hospitalization, and 3806 patients developed dementia during a median follow-up of 3.4years. The median time to dementia was 2.2years. Each one-order increase in inpatient anticholinergic medications was associated with a 0.60% increase in dementia risk (HR 1.006; 95% CI 1.003-1.008). This association was stronger among patients who were prescribed anticholinergics before hospitalization (RERI 0.10; 95% CI 0.08-1.12; p=0.0122). Perioperative anticholinergics may increase the risk of dementia after major surgery. Avoiding these medications in hospitalized older adults may improve long-term cognitive outcomes.

High-sensitivity C-reactive protein and risk of retinal artery occlusion and ischaemic stroke: a cross-cohort study

AimsPrevious studies have suggested an association between retinal artery occlusion (RAO) and ischaemic stroke (IS), both associated with elevated inflammatory factors. However, the role of high-sensitivity C-reactive protein (hs-CRP) in...

Nonlinear relationship between hepatic steatosis index and reversion to normal glucose regulation in Chinese adults with prediabetes.

The hepatic steatosis index (HSI) has been demonstrated to have a significant correlation with prediabetes and diabetes; however, its potential association with reversion to normal glucose regulation (NGR) from prediabetes remains insufficiently investigated. The primary objective of this study was to elucidate the relationship between HSI levels and the probability of reversion to NGR among Chinese adults with prediabetes. This retrospective cohort study utilized health examination data from 11,241 Chinese adults with prediabetes. Cox proportional hazard models were employed to calculate hazard ratios (HR) and 95% confidence intervals (CI) to assess the association between HSI levels and reversion to NGR. Additionally, a Cox proportional hazards regression model incorporating cubic spline functions and smooth curve fitting was utilized to determine any nonlinear relationships between HSI levels and reversion to NGR. The results of the multivariate analyses demonstrated a significant association between reduced HSI levels and an increased likelihood of reversion to NGR (HR = 0.92, 95%CI: 0.89-0.95, P < 0.0001). Furthermore, a nonlinear relationship was identified between HSI levels and the reversion to NGR, with a critical threshold at an HSI value of 43.08. Below this threshold, a strong negative association was observed, markedly enhancing the probability of returning to normoglycemic status (HR = 0.91, 95% CI: 0.88-0.94, P < 0.0001). This study reveals a negative, nonlinear correlation between HSI levels and the reversion to NGR in individuals with prediabetes. These findings highlight the essential role of effectively managing HSI as part of comprehensive prediabetes treatment strategies, which may significantly enhance the likelihood of achieving normoglycemic status.

Deep Learning Analysis of Google Street View to Assess Residential Built Environment and Cardiovascular Risk in a U.S. Midwestern Retrospective Cohort.

Cardiovascular disease (CVD) is a leading global cause of mortality. Environmental factors are increasingly recognized as influential determinants of cardiovascular health. Nevertheless, a finer-grained understanding of the effects of the built environment remains crucial for comprehending CVD. We sought to investigate the relationship between built environment features, including residential greenspace and sidewalks, and cardiovascular risk using street-level imagery and deep learning techniques. This study employed Google Street View (GSV) imagery and deep learning techniques to analyze built environment features around residences in relation to major adverse cardiovascular events (MACE) risk. Data from a Northeast Ohio cohort were utilized. Various covariates, including socioeconomic and environmental factors, were incorporated in Cox Proportional Hazards models. Of 49,887 individuals included, 2,083 experienced MACE over a median follow-up of 26.86 months. Higher tree-sky index and sidewalk presence were associated with reduced MACE risk (HR: 0.95, 95% CI: 0.91-0.99, and HR: 0.91, 95% CI: 0.87-0.96, respectively), even after adjusting for demographic, socioeconomic, environmental, and clinical factors. Visible vertical greenspace and sidewalks, as discerned from street-level images using deep learning, demonstrated potential associations with cardiovascular risk. This innovative approach highlights the potential of deep learning to analyze built environments at scale, offering new avenues for public health research. Future research is needed to validate these associations and better understand the underlying mechanisms.

Cardiovascular and Renal Outcomes with Ertugliflozin by Baseline Use of Renin–Angiotensin–Aldosterone System Inhibitors or Diuretics, Including Mineralocorticoid Receptor Antagonists: Analyses from the VERTIS CV Trial

Introduction: VERTIS CV was a placebo-controlled cardiovascular (CV) outcome trial evaluating the sodium-glucose cotransporter 2 inhibitor ertugliflozin in patients with type 2 diabetes and established atherosclerotic CV disease. The aim of the current analyses was to evaluate VERTIS CV cardiorenal outcomes according to baseline use of renin–angiotensin–aldosterone system (RAAS) inhibitors or diuretics, including mineralocorticoid receptor antagonists (MRAs). Methods: Participants received ertugliflozin 5 mg, ertugliflozin 15 mg, or placebo once daily and were followed for a mean of 3.5 years. Prespecified CV and kidney outcomes were analyzed by Cox proportional hazard modeling in participant subgroups defined by baseline use of RAAS inhibitors (angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers) or diuretics (loop diuretics, non-loop diuretics, MRAs), with interaction testing to assess for treatment effect modification. Results: A total of 8246 patients were randomized in VERTIS CV. At baseline, 6686 (81%) participants were being treated with RAAS inhibitors, 3542 (43%) with diuretics, 1252 (15%) with loop diuretics, and 674 (8%) with MRAs. No significant interactions were observed for cardiorenal outcomes by baseline use of RAAS inhibitors or MRAs (Pinteraction &gt; 0.05 for all). Statistically significant interactions for a first event of hospitalization for heart failure (HHF) or CV death, and of HHF (alone), were observed with baseline use of diuretics, including loop diuretics, with an increased benefit of ertugliflozin treatment versus placebo. Conclusion: In VERTIS CV, baseline use of diuretics, particularly loop diuretics, identified a subgroup that demonstrated greater benefit with ertugliflozin on first HHF/CV death and HHF outcomes, with no modification of treatment effect observed with baseline use of RAAS inhibitors or MRAs. There was no evidence of treatment effect on the kidney composite outcomes by baseline use of RAAS inhibitors, diuretics, loop diuretics, or MRAs. ClinicalTrials.gov identifier: NCT01986881

Repeated OGTT Versus Continuous Glucose Monitoring for Predicting Development of Stage 3 Type 1 Diabetes: A Longitudinal Analysis.

Evidence for using continuous glucose monitoring (CGM) as an alternative to oral glucose tolerance tests (OGTTs) in presymptomatic type 1 diabetes is primarily cross-sectional. We used longitudinal data to compare the diagnostic performance of repeated CGM, HbA1c, and OGTT metrics to predict progression to stage 3 type 1 diabetes. Thirty-four multiple autoantibody-positive first-degree relatives (FDRs) (BMI SD score [SDS] <2) were followed in a multicenter study with semiannual 5-day CGM recordings, HbA1c, and OGTT for a median of 3.5 (interquartile range [IQR] 2.0-7.5) years. Longitudinal patterns were compared based on progression status. Prediction of rapid (<3 years) and overall progression to stage 3 was assessed using receiver operating characteristic (ROC) areas under the curve (AUCs), Kaplan-Meier method, baseline Cox proportional hazards models (concordance), and extended Cox proportional hazards models with time-varying covariates in multiple record data (n = 197 OGTTs and concomitant CGM recordings), adjusted for intraindividual correlations (corrected Akaike information criterion [AICc]). After a median of 40 (IQR 20-91) months, 17 of 34 FDRs (baseline median age 16.6 years) developed stage 3 type 1 diabetes. CGM metrics increased close to onset, paralleling changes in OGTT, both with substantial intra- and interindividual variability. Cross-sectionally, the best OGTT and CGM metrics similarly predicted rapid (ROC-AUC = 0.86-0.92) and overall progression (concordance = 0.73-0.78). In longitudinal models, OGTT-derived AUC glucose (AICc = 71) outperformed the best CGM metric (AICc = 75) and HbA1c (AICc = 80) (all P < 0.001). HbA1c complemented repeated CGM metrics (AICc = 68), though OGTT-based multivariable models remained superior (AICc = 59). In longitudinal models, repeated CGM and HbA1c were nearly as effective as OGTT in predicting stage 3 type 1 diabetes and may be more convenient for long-term clinical monitoring.

Cardiovascular disease risk prediction by Framingham risk score in women with polycystic ovary syndrome.

Despite the documented increased cardiovascular disease (CVD) risk in women with polycystic ovary syndrome (PCOS), no specific risk prediction tools are recommended for these patients. We aimed to assess the validity of the Framingham Risk Score (FRS) as a predictor of CVD risk in PCOS patients. In a community-based prospective study, 4,435 women from the Tehran Lipid and Glucose Study (TLGS) cohort were analyzed. Among them, 215 women aged 30 years or older were diagnosed with PCOS. A Cox proportional hazards model applied to assess the relationship between the FRS and CVD event. Model accuracy was evaluated using the C-statistic, while discrimination and calibration were assessed via the ROC curve, area under the ROC curve (AUC) statistics, and the Hosmer- Lemeshow test. The Cox proportional hazards (HRs) model revealed that the CVD risk increased by 38% for each one-unit increase in the FRS [HR: 1.38 (95% CI: 1.14, 1.66)] in PCOS patients. The FRS had a C-statistic of 0.765, which indicated a satisfactory fit for CVD prediction in this population. The AUC of the ROC curve was 0.82, which demonstrated a good discrimination of the FRS. The Hosmer-Lemeshow test showed that the predicted probabilities of CVD were consistent with the observed CVD rates (p = 0.217), indicating a good calibration. This study revealed a significant increase in CVD risk among PCOS patients. The FRS effectively predicts a 38% increment in CVD risk for every one-unit increase in the FRS. Our study further validated the FRS as a predictor of CVD risk in these patients.

Postoperative radiotherapy improves survival in completely resected non-small cell lung cancer with pathologic N2 stage IIIA and positive lymph node count greater than one: a SEER-based retrospective cohort study

ObjectiveNon-small cell lung cancer (NSCLC) constitutes approximately 85% of lung cancer cases, with 20%–30% of patients diagnosed at stage III. While multimodal therapy is the standard for treating locally advanced NSCLC, the role of PORT remains controversial. This study seeks to evaluate the effect of postoperative radiotherapy (PORT) on overall survival (OS) and cancer-specific survival (CSS) in patients with resected pathologic N2 (pN2) stage IIIA NSCLC.MethodsData from the Surveillance, Epidemiology, and End Results Program (SEER) 17 registry (2010–2019) were analyzed. The cohort included 1,471 patients aged 65 years or older, diagnosed with stage IIIA pN2 NSCLC, who had undergone lobectomy or total pneumonectomy. Patients who had received neoadjuvant chemotherapy or radiotherapy were excluded. Univariate and multivariate analyses were conducted to assess the association of PORT with OS and CSS. Kaplan-Meier survival curves were employed to estimate survival outcomes, while the COX proportional hazards model was utilized for comparative analysis. PLN counts were stratified into two categories: ≤1 and &amp;gt;1.ResultsAmong the 1,471 patients included in the study, 613 (41.67%) received PORT, while 858 (58.33%) did not. PORT was associated with a significantly higher 1- and 3-year OS (89.96% and 68.49%, respectively) compared to the non-PORT group (87.44% and 61.88%, respectively, P = 0.03). However, no significant difference in CSS was observed between the groups (P = 0.15). Among patients with PLN counts &amp;gt;1, PORT significantly improved OS (HR = 1.32, 95% CI = 1.04–1.68, P = 0.0016) and CSS (HR = 1.32, 95% CI = 0.99–1.70, P = 0.026), whereas no significant differences were seen in patients with PLN counts ≤1.ConclusionsThis study underscores the potential of PORT in enhancing OS in patients with resectable pN2 stage IIIA NSCLC, particularly in those with PLN counts exceeding one. These findings suggest that PORT may offer improved outcomes in patients with extensive lymph node involvement, emphasizing the need for further prospective studies to validate and expand upon these observations.

Association of Intraoperative Occult Hypoxemia With 30-Day and 1-Year Mortality.

Despite the widespread use of pulse oximetry for intraoperative estimation of arterial oxygen saturation, there is growing evidence that certain patient populations may be vulnerable to inaccurate pulse oximetry measurements and that unrecognized hypoxemia is associated with end-organ damage and adverse outcomes. In this single-center retrospective cohort study, we sought to better elucidate the relationship between intraoperative occult hypoxemia and postoperative mortality among patients undergoing anesthesia and surgery. Data were collected from our departmental data warehouse for adult patients (≥18 years) undergoing anesthesia between 2008 and 2019 with at least 1 intraoperative arterial blood gas recorded. The number of occult hypoxemic events, defined as arterial oxygen saturation (Sao2) of <88% despite oxygen saturation measured by pulse oximetry (Spo2) >92%, were determined. Mortality data were obtained from the Social Security Death Master File and used to determine 30-day and 1-year postoperative mortality. Propensity score overlap-weighted Firth logistic regression and Cox proportional-hazard modeling were performed to analyze whether at least 1 occult hypoxemic event was predictive of 30-day and 1-year mortality. There were 25,234 patients and 62,707 paired readings included in the final analysis. There were 351 patients (1.4%) with at least 1 occult hypoxemic reading. The overall 30-day mortality rate was 3.3% and 1-year mortality rate was 10.2%. In the overlap-weighted models, patients who experienced at least 1 occult hypoxemic event had significantly higher odds of both 30-day mortality (odds ratio [OR] = 2.89, 95% confidence interval [CI], 1.46-5.72, P = .002) and 1-year mortality (hazard ratio [HR] = 1.90, CI, 1.48-2.43, P < .001). There was no significant interaction between occult hypoxemia and self-reported race/ethnicity for predicting mortality. Intraoperative occult hypoxemic events are associated with significantly higher odds of 30-day and 1-year mortality, independent of self-reported race/ethnicity.

Does 10-Year Atherosclerotic Cardiovascular Disease Risk Predict Incident Diabetic Nephropathy and Retinopathy in Patients with Type 2 Diabetes Mellitus? Results from Two Prospective Cohort Studies in Southern China.

Diabetic macrovascular and microvascular complications often coexist and may share similar risk factors and pathological pathways. We aimed to investigate whether 10-year atherosclerotic cardiovascular disease (ASCVD) risk, which is commonly assessed in diabetes management, can predict incident diabetic nephropathy (DN) and retinopathy (DR) in patients with type 2 diabetes mellitus (T2DM). This prospective cohort study enrolled 2,891 patients with clinically diagnosed T2DM who were free of ASCVD, nephropathy, or retinopathy at baseline in the Guangzhou (2017-2022) and Shaoguan (2019-2021) Diabetic Eye Study in southern China. The 10-year ASCVD risk was calculated by the Prediction for ASCVD Risk in China (China-PAR) equations. Multivariable- adjusted Cox proportional hazard models were developed to estimate hazard ratios (HRs) with 95% confidence intervals (CIs). The area under the receiver operating characteristic curve (AUC) was used to evaluate predictive capability. During follow-up, a total of 171 cases of DN and 532 cases of DR were documented. Each 1% increment in 10-year ASCVD risk was associated with increased risk of DN (pooled HR, 1.122; 95% CI, 1.094 to 1.150) but not DR (pooled HR, 0.996; 95% CI, 0.979 to 1.013). The model demonstrated acceptable performance in predicting new-onset DN (pooled AUC, 0.670; 95% CI, 0.628 to 0.715). These results were consistent across cohorts and subgroups, with the association appearing to be more pronounced in women. Ten-year ASCVD risk predicts incident DN but not DR in our study population with T2DM. Regular monitoring of ASCVD risk in routine diabetes practice may add to the ability to enhance population-based prevention for both macrovascular and microvascular diseases, particularly among women.

Socioeconomic status correlates with clinical outcomes in patients with acral melanoma

ObjectivesThis study aimed to investigate the impact of socioeconomic status on survival in Chinese patients with acral melanoma.MethodsWe collected clinical and socioeconomic information of 298 primary acral melanoma patients and performed Kaplan–Meier curves, log-rank tests, Cox proportional hazards models, and Pearson’s chi-squared tests to evaluate the relationships between clinical characteristics, socioeconomic factors, and survival outcomes.ResultsAmong the clinical characteristics, age, gender, stage, Breslow thickness, and primary tumor site significantly impacted survival in acral melanoma patients (p = 0.01, p = 0.05, p &amp;lt; 0.01, p &amp;lt; 0.01, p &amp;lt; 0.01, respectively). Compared to individual socioeconomic factors such as education, occupation, medical insurance, and marital status, the socioeconomic level derived from these four dimensions accurately predicted patient survival. Patients with higher socioeconomic status demonstrated significantly reduced mortality risk (HR = 0.60, 95% CI = 0.40–0.91, p = 0.02). However, socioeconomic level was not found to be an independent prognostic factor for acral melanoma patients after multivariable adjustment. Notably, a negative correlation was observed between socioeconomic level and Breslow thickness.ConclusionSocioeconomic level is associated with survival in Chinese acral melanoma patients. However, this association may be attributable to Breslow thickness rather than socioeconomic status itself.

The association between the dietary inflammatory index during pregnancy and risk of gestational diabetes: a prospective cohort study and a meta-analysis

IntroductionTo examine the association between dietary inflammatory index (DII) and risk of gestational diabetes mellitus (GDM).MethodsA prospective birth cohort study was conducted in Iran. During the first trimester of pregnancy, food intake was measured using a food frequency questionnaire. Each participant’s DII score was calculated, and then, the Cox proportional hazard model was used to calculate the hazard ratio (HR) and 95% CI of GDM across the quartiles of DII. We systematically searched the literature to conduct a meta-analysis of observational studies (PROSPERO: CRD42022331703). To estimate the summary relative risk for the highest versus lowest category of DII, a random-effects meta-analysis was performed. The certainty of evidence was assessed using the GRADE approach.ResultsIn the prospective cohort study (n = 635 pregnant mothers), the multivariable HRs of GDM for the third and fourth quartiles of DII were 2.98 (95%CI: 1.98, 6.46) and 2.72 (95%CI: 1.11, 6.63), respectively. Based on a meta-analysis of six prospective cohorts and a case-control study (1014 cases of GDM in 7027 pregnant mothers), being in the highest category of the DII was associated with a 27% higher risk of GDM (relative risk: 1.27, 95%CI: 1.01, 1.59; I2 = 50%; low certainty of evidence). A dose-response meta-analysis suggested a positive monotonic association between DII and GDM risk.ConclusionsOur prospective cohort demonstrated a positive correlation between GDM risk and the inflammatory potential of diet in the first trimester of pregnancy. The results need to be confirmed by larger cohort studies.Clinical trial numberNot applicable.

Long-Term Survival in Children Following Heart Transplantation.

Short-term outcomes following heart transplantation in children have improved, but comparable improvements in long-term survival continues to have barriers. We sought to investigate long-term outcomes following heart transplantation and to identify protective and risk factors associated with long-term survival in children. The Pediatric Heart Transplant Society (PHTS) database was queried for heart transplant recipients from 1993 to 2010 who were ≤ 10 years of age at time of transplant. Patients with conditional graft survival > 3 years and at ≥ 10 years were analyzed. Survival and time-to-event were compared using the Kaplan-Meier method with a log-rank test for significance. Factors associated with graft loss were identified using Cox proportional hazard modeling. There were 1610 patients ≤ 10 year of age who were transplanted between 1993 and 2010 with conditional survival to 3 years post-transplant. Of those patients, there were 1170 with conditional survival to 10 years post-transplant. Patients < 1 year at transplant had improved survival compared to other age groups. Risk factors for graft loss after 3 years post-transplant were malignancy, rejection, cardiac allograft vasculopathy (CAV), age, congenital heart disease, female sex, and Black race (p value for all < 0.05). Heart transplantation remains an effective therapy in children with a growing number of long-term survivors. Risk factors for mortality in patients ≤ 10 years of age at transplant with conditional survival to 3 years post-transplant include CAV, rejection, malignancy, female sex, and Black race. Further studies are needed to understand the social and biologic causes of racial and sex disparities in pediatric transplant patients.

Effect of metoprolol exposure following myocardial infarction on future cardiovascular events: a Mendelian randomization study.

The clinical benefit of up-titration of metoprolol to a guideline-recommended target dose after myocardial infarction (MI) is unknown. Our aim was to investigate whether variation in metoprolol exposure determined by cytochrome p450 enzyme 2D6 (CYP2D6) influences the occurrence of major adverse cardiovascular events (MACE) and cardiovascular death (CV death) among patients treated with metoprolol after MI. This Mendelian randomization study was performed using individual-level data from 1554 patients treated with metoprolol after an acute MI. CYPD26 genotype was applied as a binary genetic instrument assigning patients into two metoprolol exposure groups: CYP2D6 normal metabolizers (NM) (low exposure) and CYP2D6 intermediate and poor metabolizers (IM + PM) (high exposure). The null hypothesis of no association between the CYP2D6 metabolizer subgroup and MACE or CV death was tested using the Cox proportional hazards model. All-cause mortality and individual components of MACE were included as secondary outcomes. In total, 879 (56.6%) patients were classified as NM and 675 (43.4%) as IM + PM. During the 3-year follow-up, 56 patients (6.4%) in the NM group had an outcome of MACE, and 24 (2.7%) patients died from CV disease. Corresponding frequency in the IM + PM group was 47 (7.0%) and 22 (3.3%), respectively. There was no association between genotype and MACE [unadjusted HR 1.12 (CI 0.76, 1.65)] or CV death [unadjusted HR 1.20 (CI 0.67, 2.14)], or between the CYP2D6 group and any of the secondary outcomes. In patients treated with metoprolol after MI, variation in metoprolol exposure determined by CYP2D6 did not impact the occurrence of cardiovascular events.

Mortality and factors associated with acute exacerbation after noncardiac surgery in patients with interstitial pneumonia: a retrospective study.

Acute exacerbation of interstitial pneumonia (AE-IP) is associated with high mortality rates. Although the risk factors for AE-IP have been extensively studied, given the small sample sizes, only a few risk factors have been established. This study aimed to investigate the postoperative mortality and factors associated with AE-IP. This retrospective study included 482 patients with a preoperative diagnosis of IP who underwent noncardiac surgery between December 2012 and April 2020. AE-IP was diagnosed by a radiologist using computed tomography when worsening respiratory symptoms were observed within 1 month postoperatively. The Cox proportional hazards model was used to compare mortality rates. Candidate factors associated with AE-IP were identified through logistic regression analysis using the variable selection method, followed by case-control analysis using propensity score matching to determine possible factors associated with AE-IP. The multivariable-adjusted hazard ratios for all-cause and IP-related deaths were significantly higher in patients with AE-IP than in those without AE-IP. Multivariable analysis with variable selection suggested that male sex, higher C-reactive protein (CRP) levels, fraction of inspired oxygen (FiO2) ≥ 60%, and non-lung surgery were candidate factors associated with AE-IP. Case-control analysis using propensity score matching demonstrated that patients with AE-IP had higher CRP levels (P = 0.044) and frequency of FiO2 ≥ 60% (P = 0.035) than those without AE-IP. Furthermore, a positive, nearly linear relationship was observed between FiO2 ≥ 60% duration and AE-IP incidence. Intraoperative management with FiO2 ≥ 60% and high preoperative CRP levels were significantly associated with postoperative AE-IP.