Prospective Cohort Study Design Research Articles

Understanding musculoskeletal disorders in dancers: The role of lumbopelvic muscles and movement competency

ObjectiveTo investigate whether transversus abdominis activation (TrA), hip strength, and movement competency are associated with the incidence of musculoskeletal disorder episodes (MDEs) in dancers when controlling for confounding variables. The secondary objectives were to determine if there were differences between professional and preprofessional dancers for the aforementioned factors, as well as to determine if there were differences in TrA activation and hip strength between the dominant and non-dominant sides. DesignProspective cohort study. Methods118 dancers were recruited. The independent variables were collected at the beginning of the dance season: 1) TrA activation, 2) hip strength, and 3) movement competency. To assess the development of MDEs, a weekly electronic diary was used over a 38-week period. MDEs were compiled for each dancer's whole body and subdivided into total musculoskeletal disorder episodes (all body parts) and lower quadrant musculoskeletal disorder episodes (lower limb and lower back). ResultsLower TrA, as well as higher hip abductor and external rotator strength, were associated with a lower incidence of MDEs. TrA activation (β = 0.260, p = 0.023) and hip external rotator strength (β = −0.537, p = 0.002) could significantly explain 25.4% of the variance of total MDEs, as well as 20.9% of the variance of lower quadrant musculoskeletal disorder episodes (β = 0.272, p = 0.016; β = −0.459, p = 0.011). No significant associations were found between movement competency and MDEs. ConclusionsHigher hip strength could be a protective factor for MDEs among dancers. Further studies are needed to better understand the involvement of the transversus abdominis in MDEs.

Utilization of Telemedicine to Supervise Medical Students in the Post-Acute/Long-Term Care Setting

ObjectivesTelemedicine has become a widely accepted alternative to face-to-face patient encounters. Although there have been several peer-reviewed journal articles on incorporating telemedicine into the medical school curriculum, particularly during the COVID-19 pandemic, assessments of the effectiveness of remote supervision of medical students have not been reported. This prospective cohort study of student subjects using observational survey data evaluated the efficacy of telemedicine as an educational resource by comparing learning outcomes between osteopathic medical students receiving direct (physically present) supervision with a group who received remote (telemedicine) supervision by clinical faculty within a post-acute/long-term care (PA/LTC) setting. Learning outcomes in the domains of patient rapport, attitudes, knowledge, and behavior were measured using standardized survey instruments. DesignProspective cohort study of student subjects using observational survey data. Setting and ParticipantsA total of 167 fourth-year osteopathic medical students at a teaching nursing home (TNH). MethodsA total of 167 fourth-year osteopathic medical students (OMS-4s) were randomly assigned face-to-face PA/LTC patient encounters at the TNH. The encounters were follow-up visits to residents of the TNH that were supervised by faculty geriatricians. Half were accompanied by the physician and the other half were supervised by the physician through telemedicine. Evaluation using validated survey instruments measured patient rapport, verbal communication, and physical examination skills as well as attitudes, knowledge, and behaviors of the student/subjects. ResultsA nonparametric statistical analysis of 4 dependent variables measuring patient rapport, attitudes, knowledge and behavior showed no significant difference between the 2 teaching modalities. Conclusions and ImplicationsThe results of this prospective cohort study indicate that telemedicine supervision is comparable (noninferior) to direct supervision of medical student trainees in a PA/LTC setting.

Association of the dopamine D2 receptor gene SNP rs1800497 with postoperative nausea and vomiting

BACKGROUND Postoperative nausea and vomiting (PONV) are the most frequent complications in the context of anaesthesia. Several studies suggest a contribution of genetic traits to PONV disposition. Single nucleotide polymorphisms (SNPs) located in the cholinergic receptor muscarinic 3 gene CHRM3 (rs2165870) and the potassium voltage-gated channel subfamily B member 2 KCNB2 (rs349358) have been described as independent risk factors for the occurrence of PONV. In addition, further SNPs might be associated with an increased PONV risk, for example a dopamine D2 receptor (DRD2) SNP (rs1800497). OBJECTIVE The primary aim of our study was the development of a new PONV prediction score which includes genetic information of SNPs in the genes CHRM3 and KCNB2, which have been already associated with PONV. The secondary aim of our study was to investigate the association of five additional SNPs with PONV. DESIGN Prospective cohort study. SETTING Single centre study in Germany. RESULTS We could not establish a new PONV prediction score that includes genetic information, due to limited association of the KCNB2 SNP and CHRM3 SNP with PONV. Interestingly, the GA and AA genotypes of the DRD2 rs1800497 in the dopamine D2 receptor gene were associated with PONV 24 h postoperatively, with a relative risk (RR) of GA/AA genotype vs. GG genotype of 1.5 [95% confidence interval (CI) 1.06 to 2.01, P = 0.02]. This association was independent from the Apfel score in a multivariate logistic regression analysis (RR 1.4, 95% CI 1.03 to 1.90, P = 0.03). CONCLUSION The construction of a new PONV prediction score including genetic information was not possible due to limited association of the CHRM3 and KCNB2 SNPs. However, the DRD2 GA and AA genotypes (rs1800497) were associated with PONV and this SNP might be a future candidate for further validation studies aiming for molecular-derived PONV prediction models. TRIAL REGISTRATION German Clinical Study Register – DRKS00021051.

Comparison of Retinal Nerve Fiber Layer and Ganglion Cell Complex Rates of Change in Patients with Moderate to Advanced Glaucoma

PurposeTo compare ganglion cell complex (GCC) and retinal nerve fiber layer (RNFL) rates of change (RoC) in eyes with central or moderate to advanced glaucoma. DesignProspective cohort study. Participants918 matched macular and RNFL OCT scan pairs from 109 eyes (109 patients) enrolled in the Advanced Glaucoma Progression Study with ≥2 years of follow-up and ≥4 OCT scans. MethodsWe exported GCC and RNFL thickness measurements in 49 central macular superpixels and 12 RNFL clock-hour sectors, respectively. We applied our latest Bayesian hierarchical longitudinal model to estimate population and subject-specific baseline thickness (intercepts) and rates of change (RoC) in macular superpixels and RNFL sectors. Global RNFL and GCC RoC were analyzed in a single bivariate longitudinal model to properly compare them accounting for the correlation between their RoC. Main Outcome MeasuresProportion of significant negative (deteriorating) and positive (improving) RoC expressed in μm/year. Standardized RoC were calculated by dividing RoC by the corresponding population SD. Analyses were repeated in eyes with visual field mean deviation (MD) ≤–6 and >–6 dB. ResultsAverage (SD) 24-2 visual field MD and follow-up length were –8.6 (6.3) dB and 4.2 (0.5) years, respectively. Global RNFL RoC (–0.70 µm/year) were faster than GCC (–0.44 µm/year) (p<.001); corresponding normalized RoC were not significantly different (p=0.052). In bivariate analysis, patients with a significant negative global RNFL RoC (n=63, 57%) or GCC (n=56, 51%) frequently did so for both outcomes (n=49, 45%). The average proportion of significantly decreasing RNFL sectors within an eye was 30.7% in eyes with MD >–6 dB compared to 20.5% in those with MD ≤–6 dB (p=0.014); the proportions for GCC superpixels were 21.1% vs. 18.7%, respectively (p=0.63). ConclusionsBoth GCC and RNFL measures can detect structural progression in glaucoma patients with central damage or moderate to advanced glaucoma. The clinical utility of RNFL imaging decreases with worsening severity of glaucoma.

Dietary inflammatory index, mediating biomarkers and incident frailty in Chinese community-dwelling older adults

ObjectivesDiet can modulate systemic inflammation, while inflammation is a critical contributory factor of frailty. However, longitudinal data on the association between dietary inflammatory index (DII) and frailty are limited, and the intermediate mechanisms remain unclear. This study aimed to examine the association between DII and incident frailty and the potential mediating roles of frailty-related biomarkers. DesignProspective cohort study. SettingThe Mr. OS and Ms. OS (Hong Kong) study. ParticipantsA total of 3,035 community-dwelling men and women aged above 65 years without frailty at baseline were included. MeasurementsDII scores were calculated using the locally validated food frequency questionnaire. Incident frailty at year four was defined using the Fried frailty phenotype. Logistic regression was used to examine the association between DII and frailty onset. Mediation analysis was used to explore the mediating roles of frailty-related biomarkers in the DII-frailty association. ResultsDuring four years of follow-up, 208 individuals developed frailty. Compared with the lowest tertile of DII, the highest tertile was associated with an increased risk of incident frailty (OR: 1.82; 95% CI: 1.17–2.82; p = 0.008) after adjustment for relevant confounders. The DII-frailty association was significant in men but not in women. Furthermore, increasing serum homocysteine, decreasing serum folate, and reducing estimated glomerular filtration rate (eGFR) mediated 11.6%, 7.1%, and 9.6 % of the total relation between DII and frailty onset, respectively. ConclusionIn this cohort study, a pro-inflammatory diet was associated with a higher risk of frailty onset, mediated by homocysteine, folate, and renal function.

‘There’s more to life than staring at a small screen’: a mixed methods cohort study of problematic smartphone use and the relationship to anxiety, depression and sleep in students aged 13–16 years old in the UK

BackgroundDepression and anxiety are common in adolescents and have increased over the last decade. During that period, smartphone usage has become ubiquitous.ObjectivesThe study aim was to assess the association between...

Changes of individual retinal layer thickness post-uneventful cataract surgery determined by spectral-domain optical coherence tomography over a 3-months period

PurposeTo evaluate retinal thickness changes of individual retinal layers using spectral-domain optical coherence tomography (SD-OCT) after uneventful cataract surgery over a 3-months period. DesignProspective cohort study. Methods41 patients who underwent uneventful cataract surgery were included. Retinal SD-OCT images of both eyes were acquired preoperatively, 1 day after surgery as well as 1 month and 3 months postoperatively. Changes of retinal layer thickness were estimated after semi-automated segmentation for the following individual layers in the central subfield (CS, 1 mm) and inner ring (IR, 1–3 mm) of the early treatment diabetic retinopathy study (ETDRS) grid: retinal nerve fiber layer (RNFL), ganglion cell layer (GCL), inner plexiform layer (IPL), RNFL-GCL-IPL complex, inner nuclear layer (INL), outer plexiform layer (OPL), INL-OPL complex, outer nuclear layer (ONL), inner retina layer (IRL) and the total retina (TR). Furthermore, a sub-analysis with exclusion of patients devoid CME and an analysis in regard of patient age, lens status of the fellow eye, best corrected visual acuity and duration of surgery was conducted. ResultsThis study found significant alterations in all analysed retinal layers except for the RNFL (p = 0.33) and the GCL (p = 0.06) in the central subfield and the INL-OPL complex (p = 0.07) in the inner ring over the 3-months period (all p < 0.05). Retinal thickness decreases on the first postoperative day, followed by a significant increase 1 month after surgery and subsequent reduction at 3 months following uneventful cataract surgery could be observed. ConclusionThese results assume the hypothesis that the apex of inflammatory response, characterized by an augmentation in the thickness of individual retinal layers, occurs around 1 month after uneventful cataract surgery, and subsequently experience a reduction in activity. Therefore, we suggest that additional therapy for cystoid macular edema does not have to be initiated as early as the first month in mild cases.

Changes in injury and illness incidence and burden in elite junior male Australian footballers over a 6–year period

ObjectivesThe study aimed to determine a contemporary multi-year junior Australian football (AF) injury and illness profile and secondly, explore changes in incidence and burden over the six-year period. DesignProspective cohort study. MethodsThis study involved an elite male junior Under-18 competition and included six seasons of injury data between 2015 and 2021. A total of 1559 eligible players were included in the analysis. An injury was defined as ‘any physical or medical condition that resulted in a player missing one or more regular competition season matches.’ A Poisson regression model determined injury and illness incidence and burden across the league over a 6-year period and explored changes in injury incidence and burden over time. ResultsThe frequency of injuries was 1023 over the six seasons. The most frequently reported injuries were ankle sprain or joint injuries (26.5 injuries/season), hamstring strains (15.8 injuries/season), and concussion (15.1 injuries/season). The most burdensome injuries were ankle sprain or joint injuries with 82.5 missed matches/season, followed by anterior cruciate ligament injuries with 53.7 missed matches/season and hamstring strains with 46.9 missed matches/season. Injury incidence did not change for the most common injury types over time (all p > 0.05). Injury burden significantly increased for concussions, ACL injuries, MCL injuries, and ankle sprain or joint injuries (all p < 0.05). ConclusionsThe multi-year injury surveillance methodology identified injuries with the highest consistent incidence and those that caused the most burden to elite male junior AF players. The results can be used to reliably guide future injury prevention methodologies to reduce the impact on players and clubs.

Coverage from medical teams and injury/illness epidemiology within youth athletics in Africa: A prospective study during the 2023 African Youth Under 18/20 Athletics Championships

ObjectivesTo describe athletes' coverage by national medical teams, and injuries and illnesses occurring during the four weeks before and during the 2023 African Youth Under 18/20 Athletics Championships. DesignCross-sectional and prospective cohort study design. MethodsWe conducted a study with data collection of: 1) national medical teams, 2) injury and illness complaints during the four weeks preceding the championships using an online pre-participation health questionnaire, and 3) newly incurred in-championship injuries and illnesses collected by national medical teams and the local organising committee using daily standardised online report forms, for all registered athletes at the championships. ResultsAmong the 43 countries participating at the championships, 15 (34.9 %) countries had a medical team with at least one medical personnel. Of the 15 countries, 6 (40.0 %) countries had at least one physiotherapist and one physician, 4 (26.7 %) countries had only physiotherapist(s), and 5 (33.3 %) countries had only physician(s). Nine (60 %) countries participated in the injury surveillance study, including 397 athletes: 61 (15.4 %) completed the pre-participation health questionnaire and 11 athletes (18.0 %) reported an injury complaint and 6 (9.8 %) an illness complaint during the four weeks before the championships. During the championships, there were 52.9 injuries and 50.4 illnesses per 1000 registered athletes. The main injury location was the thigh (33.3 %), and the main injury type was the muscle (47.6 %). The most common system affected by illness was the upper respiratory tract (55.0 %), and the main illness cause was idiopathic (50.0 %). ConclusionsThis preliminary study provides foundational information to improve medical coverage and services during international championships, and orient injury/illness prevention in youth athletics across Africa.

Risk factors associated with medical encounters in ultramarathon race starters – Data from 103,131 race starters over 90 km: SAFER XLI

ObjectivesTo identify the risk factors associated with all medical encounters (MEs) and serious/life-threatening MEs (SLMEs) during the Comrades Marathon. DesignProspective cohort study, with cross-sectional analyses. MethodsDuring the 2014–2019 Comrades Marathon, all MEs (including SLMEs) were recorded in 103,131 starters. For both all MEs and SLMEs, the following risk factors were explored: sex, age, route (“up” vs. “down” race), previous Comrades experience (yes/no), wet-blub globe temperature (WBGT) and race pace. Incidence (per 1000 starters; 95%CI), and the incidence ratio (IR; 95%CI) are presented. ResultsFor all MEs, being female was a significant risk factor (females vs. males IR = 1.47, p < 0.0001), and age was only marginally significant (p = 0.0167). Therefore factors for all MEs were adjusted for sex. Other factors significantly associated with all MEs were: higher WBGT (highest WBGT compared to lowest, IR = 1.33, p = 0.0003), race pace (highest risk for those who finish either among the first quarter [IR = 1.49] or last quarter [IR = 1.46] compared to middle pace; p < 0.0001) and the route (“down” vs. “up”: IR = 1.11; p = 0.0181). Factors associated with higher risk for SLMEs were: females (IR = 1.9; p = 0.0003), “down” vs. “up” route (IR = 1.37; p = 0.0306) and race pace (slower and faster runners vs. mid (6.4–7.1 min/km) race pace category (IR > 2.1, p < 0.0001)). ConclusionsIntrinsic (female, faster and slower race pace) and extrinsic (higher WBGT and the “down” route) are novel risk factors associated with all MEs at this event. These can be considered by the race organizers and the medical team to develop and implement prevention strategies.

Association of anemia with all-cause mortality in Chinese centenarians: a prospective cohort study

ObjectivesThis study aimed to examine the relationship between anemia and all-cause mortality in Chinese centenarians. DesignProspective cohort study. Setting and participantsWe included 1002 Chinese centenarians from the China Hainan Centenarian Cohort Study (CHCCS) MeasurementsStandard procedures were followed to perform blood analysis, home interviews, and physical examinations. Anemia was defined as a hemoglobin level of less than 130 g/L for men and less than 120 g/L for women. ResultsDuring the 9-year follow-up period, a total of 929 (92.7%) deaths were identified. Cox proportional hazards regression models revealed that anemia (hazard ratio [HR] 1.289, 95% confidence interval [CI]: 1.117–1.489) was significantly associated with all-cause mortality. There was an apparent dose-response relationship between anemia and all-cause mortality. Centenarians with severe anemia had approximately 1.6 times higher likelihood of all-cause mortality than those without anemia (HR 1.662; 95% CI: 1.154–2.394). ConclusionAnemia is associated with an increased risk of all-cause mortality in Chinese centenarians. Further research will be needed to collect more comprehensive data on the etiology of anemia and causes of death in centenarians.

Development and External Validation of a Machine Learning–based Fall Prediction Model for Nursing Home Residents: A Prospective Cohort Study

ObjectivesTo develop and externally validate a machine learning–based fall prediction model for ambulatory nursing home residents. The focus is on predicting fall occurrences within 6 months after baseline assessment through a binary classification task, aiming to provide staff with an effective and user-friendly fall-risk assessment tool. DesignProspective cohort study. Setting and ParticipantsA total of 864 older residents living in 4 nursing homes between May 2022 and March 2023 in China. MethodsPotential fall-risk predictors were collected through in-person interviews and assessments of anthropometric and physical function. Participants were followed for 6 months, with falls recorded by trained nurses. Seven machine learning algorithms, including Logistic Regression (LR), Gradient Boosting Machine (GBM), eXtreme Gradient Boosting (XGBoost), Random Forest (RF), Support Vector Machine (SVM), Neural Networks (NN), and Decision Tree (DT), were used to develop prediction models. Performance was evaluated using the area under the receiver operating characteristic curve (ROC-AUC) and Precision-Recall curve (PR-AUC), with calibration assessed via a calibration curve. Feature importance was visualized using SHapley Additive exPlanations (SHAP). ResultsThe 6 selected predictors were balance, grip strength, fatigue, fall history, age, and comorbidity. The ROC-AUC for the models ranged from 0.710 to 0.750, PR-AUC from 0.415 to 0.473, sensitivity from 0.704 to 0.914, and specificity from 0.511 to 0.687 in the validation cohort. The LR model was converted into a nomogram. Conclusions and ImplicationsThe machine learning–based fall-prediction models effectively identified nursing home residents at high risk of falls. The developed nomogram can be integrated into clinical practice to enhance fall risk assessment protocols, ultimately improving patient safety and care in nursing homes.

Leisure Activity, Childhood Starvation, and Risk of Incident Diabetes in Older Adults: Evidence From a Chinese Nationwide Cohort Study

ObjectiveThis study explores the impact of leisure activity and the association between childhood starvation and the risk of diabetes in older Chinese adults. DesignProspective cohort study based on the Chinese Longitudinal Healthy Longevity Study (CLHLS), a nationwide cohort study in China. Setting and participantsA total of 4637 older adults aged ≥65 years, all with documented diabetes history, experiences of childhood starvation, and participation in leisure activities were recruited. MethodsChildhood starvation exposure was assessed via self-reported responses from a structured questionnaire. The leisure activities were measured by 9 distinctive components and categorized into 3 distinct categories: productive activity, recreational activity, and sedentary activity. Diabetes status was determined by self-reported, physician-diagnosed cases during the follow-up period. Nonparametric survival models were employed for analysis. ResultsOver an average follow-up period of 4.3 years, 215 of 4637 participants (4.6%) reported a confirmed diagnosis of diabetes. Nonparametric survival models showed that those reporting childhood starvation had a higher risk of late-life diabetes [hazard ratio (HR) 1.72, 95% CI 1.21-2.44]. Engaging in productive activity (HR 0.90, 95% CI 0.83-0.99) and recreational activity (HR 0.88, 95% CI 0.77-1.00) was linked with a reduced risk of late-life diabetes. Sedentary activity did not show a significant effect. Further analysis highlighted the interactions effects of leisure activities on diabetes risk across different demographic and historical exposure subgroups. Conclusions and implicationsEngaging in productive and recreational leisure activities was inversely associated with the risk of diabetes in older adults who experienced childhood starvation. Promoting such activities could be beneficial in mitigating long-term diabetes risk related to early-life nutritional deficiencies.

A prospective cohort study on the improvement of disease-free progression survival in patients with hepatocellular carcinoma by combining Sophora japonica granules with targeted and immune checkpoint inhibitors.

e16187 Background: To evaluate the clinical efficacy of combining Sophora japonica granules with targeted therapy and immune checkpoint inhibitors (ICIs) in patients with unresectable hepatocellular carcinoma (HCC) who had not undergone systemic treatment. Methods: A prospective cohort study design was adopted (ChiCTR2400079626), collecting HCC patients visited the Traditional Chinese Medicine Hospital of Xinjiang Uygur Autonomous Region from July 1, 2019, to July 1, 2023. All patients received targeted therapy and ICIs treatment. "Whether Sophora japonica granules were combined during treatment" was considered as the exposure factor. Patients who met this exposure factor were included in the exposure group (n = 48), and those who did not meet this factor were included in the non-exposure group (n = 44). The disease-free survival (PFS), six-month PFS rate, and subgroup analysis between two groups. Results: The PFS of the exposure group was 8.9 months (m), and that of the non-exposure group was 5m(P = 0.001 HR = 0.50, 95%CI (0.32~0.78)). The six-month PFS rates were 66.7% compared to 34.1%(P = 0.001). Subgroup analysis showed that in subgroups with hepatitis, cirrhosis, vascular invasion, extrahepatic metastasis, tumor maximum diameter ≥5cm, combined TKI, the exposure group had significantly longer PFS than the non-exposure group (respectively: 9m VS 5m, 10m VS 4m, 13m VS 3m, 8.3m VS 4m, 9m VS 4m, 9m VS 5m),(P &lt; 0.05). In the subgroup with a history of alcohol consumption, the exposure group's PFS was extended by 9 m (14m VS 5m; P = 0.010); in the subgroup with baseline AFP ≥400ng/ml, PFS was extended by 6m (9m VS 3m; P = 0.017), and in the subgroup with baseline AFP &lt; 400ng/ml, PFS was also extended by 2.9m (8.9m VS 6m; P = 0.024), with all differences being statistically significant. Multivariate analysis showed that extrahepatic metastasis was an independent prognostic factor, with a disease progression risk 1.77 times higher than that of patients without extrahepatic metastasis [HR = 1.77, 95%CI (1.11~2.81), P = 0.016]. Combining Sophora japonica granules was a protective factor [HR = 0.53, 95%CI (0.33~0.84), P = 0.006], reducing the risk of disease progression in HCC patients treated with targeted therapy and ICIs by 47%. Conclusions: Combining Sophora japonica granules can extend the progression-free survival of HCC patients treated with targeted therapy and ICIs, increase the six-month PFS rate, and significantly reduce the risk of disease progression. The survival benefit was more pronounced in subgroups with vascular invasion and a history of alcohol consumption, with PFS exceeding one year. After combining Sophora japonica granules, the survival benefit improved more in the ICIs + TKI subgroup compared to the ICIs + bevacizumab subgroup. Clinical trial information: ChiCTR2400079626.

Training injuries in elite men's senior and academy (Super League) rugby league; an analysis of 224,000 exposure-hours

ObjectivesReport two-years of training injury data in senior and academy professional rugby league. DesignProspective cohort study. MethodsMatch and training time-loss injuries and exposure data were recorded from two-seasons of the European Super League competition. Eleven/12 (2021) and 12/12 (2022) senior and 8/12 (2021) and 12/12 (2022) academy teams participated. Training injuries are described in detail and overall match injuries referred to for comparison only. Results224,000 training exposure hours were recorded with 293 injuries at the senior (mean [95 % confidence interval]; 3 [2–3] per 1000 h) and 268 academy level (2 [2–3] per 1000 h), accounting for 31 % and 40 % of all injuries (i.e., matches and training). The severity of training injuries (senior: 35 [30–39], academy: 36 [30–42] days-lost) was similar to match injuries. Lower-limb injuries had the greatest injury incidence at both levels (senior: 1.85 [1.61–2.12], academy: 1.28 [1.08–1.51] per 1000 h). Head injuries at the academy level had greater severity (35 [25–45] vs. 18 [12–14] days-lost; p < 0.01) and burden (17 [16–18] vs. 4 [4–5] days-lost per 1000 h; p = 0.02) than senior level. At the senior level, the incidence of contact injuries was lower than non-contact injuries (risk ratio: 0.29 [0.09–0.88], p = 0.02). ConclusionsTraining injuries accounted for about a third of injuries, with similar injury severity to match-play. Within training there is a higher rate of non-contact vs. contact injuries. Whilst current injury prevention interventions target matches, these data highlight the importance of collecting high quality training injury data to develop and evaluate injury prevention strategies in training.

Post-irradiation dysbiosis in patients with nasopharyngeal carcinoma having received radiotherapy – A pilot study

ObjectiveTo compare the changes in the sinonasal mucosa microbiome in patients with nasopharyngeal carcinoma (NPC) before and after radiotherapy (RT), and to explore the pathogenesis of post-irradiation chronic rhinosinusitis (PI-CRS) and its association with dysbiosis. Study DesignProspective cohort study. SettingUnicenter, Tertiary referral hospital. MethodsIncluded patients newly diagnosed with NPC. Samples of ostiomeatal complex mucosa were collected before and after RT. Microbiome analysis was conducted using 16S rRNA sequencing, and statistical analysis was performed. Subgroup analyses based on RT modality (proton therapy or photon therapy) ResultsTotal of 18 patients were enrolled in the study, with 62.1% receiving intensity-modulated proton therapy (IMPT). Corynebacterium was the most dominant genus identified in both the pre- and post-RT groups, with a visible increase in Staphylococcus and a decrease in Fusobacterium genus in post-RT group. Alpha-diversity did not significantly differ between groups, although the beta-diversity analysis revealed a dispersed microbiota in the post-RT group. The functional prediction indicated a higher relative abundance of taxonomies associated with biofilm formation in the post-RT group. The subgroup analysis revealed the above changes to be more significant in patients who received photon therapy (Intensity modulated radiation therapy, IMRT). ConclusionsThis is the first study to analyze the microbiome of patients with NPC after IMPT. We identified similarities between the post-RT microenvironment and that reported in patients with CRS, with a more apparent change noted in patients treated with IMRT. Further investigation is required to further elucidate the pathogenesis of PI-CRS and its relationship to post-RT dysbiosis, particularly IMPT.

Chronic Kidney Disease Stage and Cardiovascular and Mortality Events Among Older Adults: The SPRINT Trial

Rationale & ObjectiveThe risk implications of the Kidney Disease: Improving Global Outcomes (KDIGO) CKD classification in older adults are controversial. We evaluated the risk of adverse outcomes in this population across categories of estimated glomerular filtration rate (eGFR) and urine albumin to creatinine ratio (UACR). Study DesignProspective cohort. Settings & Participants2509 participants aged ≥75 years in the Systolic Blood Pressure Intervention Trial (SPRINT). ExposuresKDIGO eGFR and UACR categories. We combined KDIGO categories G1 and G2, G3b and G4, as well as A2 and A3. OutcomesPrimary SPRINT outcome (composite of myocardial infarction, other acute coronary syndromes, stroke, heart failure, or death from cardiovascular causes), and all-cause death. Analytical ApproachMultivariable Cox proportional hazard models. ResultsMean age was 79.8 years, 37.4% were female, mean eGFR was 64.0 ml/min/1.73 m2, and median UACR 13.1 mg/g. In multivariable Cox proportional hazard analysis, compared with participants with eGFR ≥60 ml/min/1.73 m2 and UACR <30 mg/g, there was no statistically significant difference in the risk of the primary outcome among participants with eGFR 45-59 or 15-44 ml/min/1.73 m2 and UACR <30 mg/g. However, those with eGFR 45-59 or 15-44 ml/min/1.73 m2 and UACR ≥30 mg/g had higher risk of the primary outcome (HR [95% CI], 1.97 [1.27, 3.04] and 3.32 [2.23, 4.93], respectively). The risk for all-cause death was higher for each category of abnormal eGFR and UACR, with the highest risk observed among those with eGFR 15-44 ml/min/1.73 m2 and UACR ≥30 mg/g (3.34 [2.05, 5.44]). LimitationsIndividuals with diabetes and urine protein >1 g/day were excluded from SPRINT. ConclusionAmong older adults SPRINT participants, low eGFR without albuminuria was associated with higher mortality but not with increased risk of cardiovascular events. Additional studies are needed to evaluate an adapted CKD stage-based risk stratification for older adults.

Intensity-specific physical activity measured by accelerometer and the risk of mortality among individuals with cardiometabolic diseases: A prospective study from the UK Biobank

BackgroundWhile the health benefits of physical activity for general population are well-recognized, the prospective associations of physical activity volume and intensity with mortality among cardiometabolic disease individuals remain unclear. ObjectiveThe objective of this study was to investigate the associations of accelerometer-measured intensity-specific physical activity with mortality risk among population with cardiometabolic disease. DesignProspective cohort study. SettingParticipants were recruited from the United Kingdom (UK) across 22 assessment centers from 2006 to 2010. ParticipantsA total of 9524 participants from the UK Biobank (median: 67.00 years, interquartile range: 61.00–70.00 years) were included in final study. MethodsAccelerometer-measured total volume, moderate-to-vigorous and light intensity physical activity collecting from 2013 to 2015 were quantified using a machine learning model. Multivariable restricted cubic splines and Cox proportional hazard models with hazard ratios (HRs) and 95 % confidence intervals (CIs) were employed to examine the associations of interests. ResultsDuring the follow-up period (median: 6.87 years; interquartile range: 6.32–7.39 years), there were 659 (6.92 %) death events with 218 (2.29 %) cardiovascular disease-related deaths and 441 (4.63 %) non-cardiovascular disease-related deaths separately. In the fully adjusted models, compared with participants in the lowest quartiles of total volume, moderate-to-vigorous and light physical activities, the adjusted HRs (95 % CIs) of all-cause mortality for those in the highest quartiles were 0.40 (0.31, 0.52), 0.48 (0.37, 0.61), and 0.56 (0.44, 0.71) while those for cardiovascular diseases-related mortality were 0.35 (0.22, 0.55), 0.52 (0.35, 0.78) and 0.59 (0.39, 0.88), and for non-cardiovascular diseases-related mortality, they were 0.42 (0.30, 0.59), 0.40 (0.29, 0.54) and 0.54 (0.40, 0.73), separately. The optimal moderate-to-vigorous-intensity physical activity level for cardiovascular diseases-related mortality reduction was found to be in the third quartile (17.75–35.33 min/day). Furthermore, the observed inverse associations were mainly non-linear. ConclusionsPromoting physical activity, regardless of intensity, is essential for individuals with cardiometabolic disease to reduce mortality risk. For both all-cause and cardiovascular disease-related and non-cardiovascular disease-related mortality, the observed decrease in risk seems to level off at a moderate level. The current findings deriving from precise device-based physical activity data provide inference for secondary prevention of cardiometabolic disease.

Influencing risk factors of voriconazole-induced liver injury in Uygur pediatric patients undergoing allogeneic hematopoietic stem cell transplantation

PurposeWe aimed to investigated the influencing risk factors of voriconazole-induced liver injury in Uygur pediatric patients undergoing allogeneic hematopoietic stem cell transplantation (HSCT).MethodsThis was a prospective cohort design study. High-performance liquid chromatography-mass spectrometry was employed to monitor voriconazole concentration. First-generation sequencing was performed to detect gene polymorphisms. Indicators of liver function were detected at least once before and after voriconazole therapy.ResultsForty-one patients were included in this study, among which, 15 patients (36.6%) had voriconazole-induced liver injury. The proportion of voriconazole trough concentration > 5.5 μg·mL−1 patients within the DILI group (40.0%) was significantly higher compared to the control group (15.4%) (p < 0.05). After administration of voriconazole, the values of ALT (103.3 ± 80.3 U/L) and AST (79.9 ± 60.6 U/L) in the DILI group were higher than that in the control group (24.3 ± 24.8 and 30.4 ± 8.6 U/L) (p < 0.05). There was no significant difference between the two groups in genotype and allele frequencies of CYP2C19*2, CYP2C19*3, CYP2C19*17, and UGT1A4 (rs2011425) (p > 0.05).ConclusionThere was a significant correlation between voriconazole-induced liver injury and voriconazole trough concentration in high-risk Uygur pediatric patients with allogeneic HSCT.

Blood Urea Nitrogen-Serum Albumin Ratio As a Predictor of Clinical Outcome in Acute Ischemic Stroke

Stroke is a global health issue with high morbidity and fatality rates. Treatment decisions for ischemic stroke rely on clinical outcome prediction. The NIHSS score is commonly used to predict the AIS's clinical outcomes. However, its use is hindered by its complexity, which requires the assessment of many variables. Therefore, there is an urgent need to develop a simpler yet still effective evaluation tool in assessing the AIS’s clinical outcome. The study aimed to predict AIS outcomes using the blood urea nitrogen to albumin serum ratio (RBA). This study was a prospective cohort study design, with subjects being first-time AIS patients hospitalized at RSUP Dr. Wahidin Sudirohusodo and several hospitals in Makassar from December 2022–April 2023. Demographic and clinical data were collected, assessing RBA and comparing it according to the good (mRS 0-2) and poor (mRS 3-6) outcome groups. RBA performance was assessed by receiver operating characteristic curve (ROC) analysis to assess the AIS's clinical outcome. The study's findings on 62 participants meeting the criteria revealed a significant association between RBA and the AIS's clinical outcome (p-value=0,0004). The mean RBA differed significantly between the good and poor AIS outcome groups (p-value =0,006). In the ROC analysis, the area under the curve (AUC) was 0,75 with an optimal cut-off value was 2,05, yielding a sensitivity of 41,67%, a specificity of 98%, and a likelihood ratio of 20,83 (p-value=0,007). In conclusion, RBA can be used as a simple and objective tool to determine the clinical outcome predictors of AIS.