Disease Rating Research Articles

Improving Blood Pressure Control and Tobacco Use Cessation Intervention In Primary Care: Protocol for the Alabama Cardiovascular Cooperative Heart Health Improvement Project.

Alabama has the second highest rate of cardiovascular disease (CVD) mortality of any US state and a high prevalence of CVD risk factors such as hypertension, diabetes, obesity, and smoking. Within the state, there are disparities in CVD outcomes and risk factors by race or ethnicity and geography. Many primary care practices do not have the capacity for full-scale quality improvement (QI) initiatives. The Alabama Cardiovascular Cooperative (ALCC), which includes academic and community stakeholders, was formed to support primary care practices to implement QI initiatives to improve cardiovascular health. The ALCC is implementing a Heart Health Improvement Project (HHIP) in primary care practices with suboptimal rates of blood pressure (BP) control and tobacco use screening. The study aimed to support primary care practices to increase BP control among adults with hypertension and increase rates of tobacco use screening and cessation intervention. We are using a type 1 hybrid design to test the effects of the HHIP on BP control among adults with hypertension and tobacco use screening and cessation intervention, while collecting information on implementation. Primary care practices were recruited through existing practice networks and additional electronic and in-person outreach. To ensure participation from a broad range of clinics, we required at least 50% of practices to be Federally Qualified Health Centers or look-alikes and to include representation from practices in rural areas. At baseline, we collected information about practice characteristics and preintervention rates of BP control and tobacco use screening and cessation intervention. The QI intervention includes quarterly activities conducted over a 12-month period. The HHIP uses a multipronged approach to QI, including practice facilitation and technical assistance, on-site and e-learning, and improvement through data transparency. We will conduct a pre-post analysis to estimate the effects of the HHIP and whether there is an enduring change in outcomes after the 12 months of HHIP activities beyond what would be expected due to secular trends. Practice recruitment took place between April 2021 and October 2022. After contacting 417 primary care practices, 51 were enrolled, including 28 Federally Qualified Health Centers or look-alikes; 47 practices implemented the HHIP. Among 45 practices that completed the baseline survey, 11 (24%) were solo practices, while 28 (62%) had 1-5 clinicians, and 6 (13%) had 6 or more clinicians. The median number of patient visits per year was 5819 (IQR 3707.3-8630.5). Practices had been in operation for a mean of 19.2 (SD 13.0) years. At baseline, the mean BP control rate was 49.6% and the rate of tobacco use screening and cessation intervention was 67.4%. If successful, the ALCC and HHIP may improve the implementation of evidence-based guidelines in primary care and, subsequently, cardiovascular health and health equity in the state of Alabama. DERR1-10.2196/63685.

Comprehensive analysis of clinical characteristics, management and prognosis in patients with dilated cardiomyopathy discharged from Spanish hospitals.

Dilated cardiomyopathy (DCM) is a leading cause of heart failure (HF) characterized by left ventricular dilatation and systolic dysfunction not explained by abnormal loading conditions. Despite its prevalence, DCM's epidemiology and prognosis remain poorly studied in our country. A retrospective observational study encompassed patients discharged from all Spanish public hospitals between 2016 and 2021 diagnosed with DCM. Data were extracted from the Minimum Basic Data Set. The study focused on hospital admissions, comorbidities, in-hospital mortality, and readmission rates for circulatory system diseases at 30 and 365 days. Among 27,402 index episodes, DCM was the primary diagnosis in 12.4%, predominantly affecting men (72.5%). In-hospital mortality was 8.7%, with significant predictors including cardiogenic shock (OR: 12.4, 95%CI: 9.6-15.9), advanced or metastatic cancer (OR: 4.3, 95%CI: 3.8-5.0), renal failure (OR: 2.4, 95%CI: 2.2-2.7), and chronic liver disease (OR: 2.4, 95%CI: 2.1-2.8). Readmission rates were 7.9% at 30 days and 25.5% at 365 days, predominantly due to HF. Multivariate analysis identified age (IRR: 1.02, 95%CI: 1.01-1.02), female sex (IRR: 0.87, 95%CI: 0.79-0.96), severe haematological diseases (IRR: 2.12, 95%CI: 1.45-3.10), and metastatic cancer (IRR: 1.65, 95%CI: 1.31-2.07) as predictors of 30-day readmissions. At 365 days, predictors included age (IRR: 1.02, 95%CI: 1.01-1.02), female sex (IRR: 0.80, 95%CI: 0.74-0.86), severe haematological diseases (IRR: 2.43, 95%CI: 1.66-3.56), and renal failure (IRR: 1.42, 95%CI: 1.31-1.55). This study highlights the substantial hospitalization burden and mortality risk among DCM patients, emphasizing the necessity for advanced management strategies and specialized cardiac care.

Low Surgery Rates in Early Crohn's Disease: Results from a Prospective Population-Based Inception Cohort-The Inflammatory Bowel Disease in South-Eastern Norway III Study.

The emergence of biologic therapy has coincided with a decline in surgery rates for Crohn's disease (CD). This study aims to describe the disease course, including intra-abdominal surgery rates, biologic therapy use, and variables associated with biologic therapy initiation in a cohort of newly diagnosed CD patients. The Inflammatory Bowel Disease in South-Eastern Norway (IBSEN) III study is a population-based inception cohort study. From 2017 to 2019, newly diagnosed inflammatory bowel disease patients were included for prospective follow-up. The present study included CD patients ≥ 18 years. Clinical, endoscopic, and demographic data were collected at diagnosis and 1-year follow-up. Data were analyzed by using the Kaplan-Meier method and regression analyses. In total, 424 CD patients (median age 37.0 years (range 18-80), female 55.0%) were included. At diagnosis, 50.5% presented with ileal disease and 80.7% with inflammatory behavior. Within a 1-year follow-up, 39.6% of patients received their first biologic therapy and 5.2% required intra-abdominal surgery. Systemic steroid treatment, CRP ≥ 5.0mg dL-1, Harvey-Bradshaw Index score > 4, ileocolonic disease and penetrating disease behavior at diagnosis were independently associated with increased risk of initiation of biologic therapy, while age > 40 years was associated with decreased risk. A high proportion of patients had ileal disease and inflammatory behavior at diagnosis. Still, nearly 40% started biologic therapy within the 1-year follow-up, while only 5% required intra-abdominal surgery.

Lung ultrasound on first postoperative day predicts out-of-hospital pulmonary complications following video-assisted thoracic surgery: A prospective cohort study.

The integration of enhanced recovery after surgery (ERAS) protocols into the peri-operative management of video-assisted thoracic surgery (VATS) has facilitated rapid patient recovery, enabling discharge within 48 h. However, postoperative pulmonary complications (PPCs) postdischarge pose significant concerns for patient welfare. Despite the established utility of lung ultrasound (LUS) in diagnosing the causes of dyspnoea, the effectiveness of quantitative LUS in predicting PPCs after VATS remains uncertain. To determine whether quantitative LUS performed 24 h after surgery can identify patients with a higher risk of developing PPCs within 30 days after discharge from hospital. Single-centre prospective cohort study. Academic tertiary care medical centre. Adults scheduled for elective VATS under general anaesthesia from November 2022 to January 2023. This primary aim was to verify the association between lung ultrasound score (LUSS) on postoperative day 1 (POD1) and PPCs. The secondary aim was to identify other relevant peri-operative factors closely related to PPCs and establish a model capable of predicting the risk of PPCs in patients undergoing fast-track VATS. Of the 200 recruited patients, 182 completed the LUS examination and 30-day follow-up. Of these, 66 (36.2%) developed various types of PPCs. These patients had a higher LUSS on POD 1 (P < 0.001), and more subpleural consolidation areas compared to those without PPCs (P < 0.001). Receiver-operating characteristics (ROC) analysis identified the optimal LUSS cut-off value at 6 points for predicting the occurrence of PPCs, with an area under the curve (AUC) of 0.838 (95% CI, 0.768 to 0.909). Patients with PPCs had higher rates of immune system diseases and ARISCAT score, longer hospital stay and procalcitonin levels, increased frequency of lobar resection, longer durations of surgical and mechanical ventilation, and greater incidence of unplanned hospital readmissions within 30 days postdischarge, compared with those without PPCs (all P < 0.001). Multivariable logistic regression analysis indicated that the comorbidity of immune system disease, along with postoperative 24 h LUSS, were independent risk factor for PPCs within 30 days after VATS. LUSS on POD 1 emerged as an independent risk factor for PPCs in fast-track VATS patients and reliably predicted the occurrence of PPCs within 30 days of hospital discharge. ClinicalTrials. gov No. ChiCTR2200065865.

Pneumonia Vaccines: Indications for Use and Current Safety Data in Pregnancy.

Streptococcus pneumoniae is a leading cause of pneumonia, meningitis, and invasive pneumococcal disease among adults in the United States, with higher rates of disease occurring among individuals with chronic medical and immunocompromising conditions. Pregnant individuals, especially those with co-morbid conditions, are also at increased risk of infection due to S. pneumoniae due to physiologic and immunologic changes in pregnancy. Vaccination against pneumococcus is recommended for adults living with HIV aged 19-49, congenital or acquired immunodeficiency, asplenia, chronic renal failure, sickle cell disease, alcohol abuse, cerebrospinal fluid leaks, congestive heart failure and cardiomyopathies, chronic lung disease, chronic liver disease, and diabetes mellitus. During pregnancy, the American College of Obstetricians and Gynecologists (ACOG) recommends vaccination against S. pneumoniae for individuals meeting criteria for immunization outside of pregnancy. Pneumococcal vaccine uptake has been low. There are no data available for vaccine uptake in pregnancy, but we suspect it is lower than non-pregnant populations. Low uptake of immunization rates in pregnancy is likely multifactorial and includes general vaccine hesitancy among pregnant individuals, cost, access to care, and supply shortages. While data in support of pneumococcal vaccines during pregnancy are limited, sufficient evidence exists to support the safety and efficacy of vaccination in the antepartum period. Pregnancy provides an opportunity to continuously engage individuals in care, allowing obstetricians and gynecologists to establish rapport, work to reduce vaccine hesitancy, and to provide pneumococcal immunization to those who are eligible. Medical indications for pneumococcal vaccination will increasingly apply to pregnant persons as the population acquires co-morbidities and there is a need for improved education among obstetricians on the topic of antenatal pneumococcal vaccination.

Deceleration capacity derived from a five-minute electrocardiogram predicts mortality in the general population

In contemporary healthcare, effective risk stratification in the general population is vital amidst rising chronic disease rates and an ageing demographic. Deceleration Capacity of the heart rate (DC), derived from 24-hour Holter electrocardiograms, holds promise in risk stratification for cardiac patients. However, the potential of short-term electrocardiograms of five minutes duration for population screening has not been fully explored. Our study aims to investigate the utility of Deceleration Capacity derived from short-term electrocardiograms as a scalable, fully-automated screening tool for predicting long-term mortality risk in the general population. Within a cohort of a representative population-based survey in Germany (KORA-KMC-study), 823 participants with sinus rhythm aged 27 to 76 years at enrollment (females 47.4%) were followed for a median of 13.4 years (IQR 13.1–13.6). All-cause mortality was defined as the primary endpoint and observed in 159 participants. Deceleration Capacity was calculated from 5-minute 12-lead electrocardiograms by a fully automated approach. Participants were divided into three predefined risk categories: DCcategory0 – low-risk (> 4.5ms); DCcategory1 – intermediate-risk (2.5-4.5ms); and DCcategory2 – high-risk (≤ 2.5ms). More than two-thirds of the participants (n = 564, 68.5%) fell into DCcategory0, about one-fifth (n = 168, 20.4%) into DCcategory1, and about one-tenth (n = 91, 11.1%) into DCcategory2. Estimated 13-years mortality in the risk groups was 16.7%, 23.5%, and 49.1%, respectively (p < 0.001). Adjusting for age, life-style-related risk factors, and comorbidities, increased mortality risk was observed for DCcategory2 (HR 2.34, 95%-CI 1.56–3.50). Deceleration Capacity, derived automatically from brief 5-minute electrocardiogram recordings, emerges as a robust, feasible, and independent predictor of long-term mortality risk in the general population.

Physical activity and incident cardiovascular disease in breast cancer survivors: the pathways study.

Breast cancer survivors experience higher rates of cardiovascular disease (CVD) than women without breast cancer, due in part to cardiotoxic cancer treatments and shared lifestyle risk factors. Physical activity is associated with lower mortality risk in breast cancer survivors, but associations with CVD have not been examined in detail. The Pathways Study is a prospective cohort study of 4,504 women diagnosed with invasive breast cancer between 2005 and 2013. At enrollment, women self-reported their physical activities during the previous six months, which were dichotomized as meeting the CDC's Physical Activity Guidelines for Americans (≥150 minutes of moderate-intensity or ≥ 75 minutes of vigorous-intensity activity per week) vs not. Incident CVD events (heart failure, cardiomyopathy, cardiac arrest, ischemic heart disease, stroke) occurring between enrollment and December 2021 were identified from electronic health records. Covariate-adjusted, competing risks Cox regression models estimated associations between meeting physical activity guidelines and CVD risk. Compared with women who did not meet physical activity guidelines at their diagnosis, those who did had a 25% lower risk of CVD (HR: 0.75, 95% CI: 0.60, 0.94). Among the individual CVD outcomes, meeting physical activity guidelines was protective against incident cardiomyopathy (HR: 0.54, 95% CI: 0.31, 0.95), heart failure (HR: 0.66, 95% CI: 0.50, 0.87), and cardiac arrest (HR: 0.68, 95% CI: 0.49, 0.99). Meeting physical activity guidelines at breast cancer diagnosis was associated with lower risk of CVD after diagnosis. Studies investigating changes in physical activity after a breast cancer diagnosis and CVD risk are warranted.

Evaluating hepatitis B screening, prevalence, vaccination coverage, and linkage to care in Abuja, Nigeria: insights from a cross-sectional study

BackgroundHepatitis B virus (HBV) is a major global health threat, especially in Sub-Saharan Africa, where Nigeria has a prevalence exceeding 8%. Despite the availability of effective vaccines, inadequate coverage and lack of awareness have resulted in high rates of chronic infections and HBV-attributable liver disease. The study aimed to raise awareness of HBV, enroll participants for HBV screening, determine HBV prevalence across various communities, vaccinate negative cases and link positive cases to care.MethodsA cross-sectional study was conducted in 16 districts of Abuja from April 2022 to March 2023. Participants aged 18 and over were screened for hepatitis B, and those testing negative were offered on-site vaccination. Blood samples were collected and tested using HBV immunochromatographic tests and real-time polymerase chain reaction (RT-PCR) for HBV DNA quantification. Data were collected through interviews and analyzed using R software, with descriptive statistics calculated for continuous and categorical variables. Associations between socio-demographic factors and hepatitis B/vaccine status were assessed using the Chi-square test of independence.ResultsOut of 3,245 individuals screened, 141 (4.3%) tested positive for HBV. The highest prevalence was observed in the 20–39 age group (5.9%), with males showing a higher infection rate (5.4%) compared to females (3.7%) [p = 0.02]. The mean age of HBV-positive individuals was significantly lower (30.8 years) than those negative for HBV (36.2 years) [p = < 0.001]. Among 2,506 participants who consented to vaccination, 2,488 received the first dose (99.3%), 1,834 the second dose (73.2%), and 1,100 the third dose (43.9%). Vaccination uptake declined with each subsequent dose, but more older participants completed the third dose. A similar pattern of HBV prevalence was observed across gender and age groups.ConclusionThe study reveals a 4.3% prevalence of hepatitis B, with the highest infection rate among individuals aged 20–39 years, and males showing a higher prevalence than females. Although vaccination uptake was high for the first dose, adherence declined for subsequent doses. These findings highlight the need for targeted public health interventions, particularly among younger adults and males, to improve awareness and vaccination completion. Enhanced community engagement and sustained vaccination efforts are crucial for reducing HBV transmission and achieving better coverage.

Diversity in Naturally Acquired Immunity to Group B Streptococcus: A Comparative Study of Women from Bangladesh, Malawi, and the United Kingdom.

Significant disparities in Group B Streptococcus (GBS) colonisation and neonatal disease rates have been documented across different geographical regions. For example, Bangladesh reports notably lower rates compared to the United Kingdom (UK) and Malawi. This study investigates whether this epidemiological variability correlates with the immune response to GBS in these regions. Qualitative and quantitative analyses of naturally acquired immunoglobulin G (IgG) antibodies against GBS capsular polysaccharides (CPS) and the Alp protein family were conducted in serum samples from women of childbearing age in the UK, Bangladesh, and Malawi. The efficacy of these antibodies in clearing vaginal colonisation or protecting newborns from GBS infection was assessed using humanised mouse models. Bangladeshi women displayed the highest diversity in serotype distribution, with elevated immunoglobulin G (IgG) levels in the serum against GBS capsular polysaccharides (CPS)- Ia, Ib, II, III, IV, and V, as well as Alp family proteins. In contrast, Malawian sera demonstrated the weakest antibody response. Bangladeshi sera also showed heightened IgG-mediated complement deposition, opsonophagocytic killing and neonatal Fc receptor (FcRn)-binding while tested against CPS Ib. In a humanised FcRn mouse model, Bangladeshi sera led to faster clearance of GBS virulent serotype Ib vaginal colonisation. Additionally, offspring from dams passively immunised with Bangladeshi sera demonstrated notably increased survival rates. This study demonstrates significant variability in the immune response to GBS across different geographical regions. These findings underscore the importance of understanding GBS-induced immune response in diverse populations, which may significantly impact vaccine efficacy in these regions.

Cognitive aspects of motor control deteriorate while off treatment following subthalamic nucleus deep brain stimulation surgery in Parkinson’s disease

IntroductionThe long-term effects of surgery for subthalamic nucleus deep brain stimulation (STN-DBS) on cognitive aspects of motor control for people with Parkinson’s disease (PD) are largely unknown. We compared saccade latency and reach reaction time (RT) pre- and post-surgery while participants with PD were off-treatment.MethodsIn this preliminary study, we assessed people with PD approximately 1 month pre-surgery while OFF medication (OFF-MEDS) and about 8 months post-surgery while OFF medication and STN-DBS treatment (OFF-MEDS/OFF-DBS). We examined saccade latency and reach reaction time (RT) performance during a visually-guided reaching task requiring participants to look at and reach toward a visual target.ResultsWe found that both saccade latency and reach RT significantly increased post-surgery compared to pre-surgery. In addition, there was no significant change in Movement Disorder Society-Unified Parkinson’s Disease Rating Scale (MDS-UPDRS) Part III score.DiscussionWe found detrimental post-surgical changes to saccade latency and reach RT. We discuss the potential contributions of long-term tissue changes and withdrawal from STN-DBS on this detrimental cognitive effect.

Review and Analysis of XAI Methods for Addressing Geoecological Zoning and Public Health Prevention Challenges

This study focuses on the application of Explainable Artificial Intelligence (XAI) in geoecological zoning tasks to support sustainable development and public health prevention. Amid increasing anthropogenic pressures on ecosystems and rising disease rates due to environmental degradation, emphasis is placed on early risk detection methods. The study highlights the importance of XAI in analyzing ecological data to mitigate the impacts of adverse factors on population health. Integrating XAI with Geographic Information Systems (GIS) not only provides high accuracy in geoecological forecasting but also enhances the transparency of these forecasts for experts, aiding informed decision-making in the fields of geoecology and healthcare. Special attention is given to early diagnosis of health risks, such as respiratory and oncological diseases, through the use of XAI in analyzing environmental data and medical images. Explainable AI enhances the transparency and understandability of diagnostic processes for medical professionals, fostering trust in analytical outcomes. Implementing XAI in healthcare can not only improve diagnostic accuracy but also optimize healthcare resources by reallocating them toward disease prevention. A review of existing decision support systems (DSS) demonstrates the efficacy of hybrid models combining neural networks and fuzzy logic to enhance the precision and interpretability of medical forecasts. These models open new prospects for personalized medicine, improving preventive strategies and providing individual recommendations based on comprehensive analyses of environmental and medical data. A critical aspect of the study is territorial zoning aimed at managing environmental risks and disease prevention. This approach not only reduces the burden on healthcare systems but also promotes sustainable territorial development, taking into account the influence of environmental and social factors on population health.

Efficacy and safety of transhepatic arterial chemoembolization with drug-loaded microspheres in unresectable primary liver cancer

BACKGROUND Transhepatic arterial chemoembolization (TACE), as a local treatment, has been widely used in the treatment of unresectable liver cancer. The introduction of drug carrier microspheres has brought new hope for the therapeutic effect of TACE. Microspheres can realize the slow release and directional delivery of drugs, reduce systemic toxicity and improve local curative effect. AIM To compare the effectiveness of traditional transcatheter arterial chemoembolization against microsphere-assisted transcatheter arterial chemoembolization in the treatment of hepatocellular carcinoma that is incurable. METHODS We searched the PubMed, Embase, Cochrane Library, and CNKI databases for clinical trials of drug-luting beads TACE (DEB-TACE) vs conventional TACE (cTACE) for the treatment of unresectable liver cancer. We screened references based on inclusion and exclusion criteria and then selected valid data for meta-analysis using RevMan 53 software. The complete response (CR) rate, partial response (PR) rate, postoperative stable disease (SD) rate, and 6-month and 12-month survival rates were compared. RESULTS A total of 12 articles were included, including 1177 patients, 519 of whom received DEB-TACE and 658 of whom received cTACE. The CR rate in the DEB-TACE group was much greater than that in the cTACE group [relative risk (RR) = 1.42, 95%CI: 1.18–1.72, P = 0.0002]. The 12-month survival rate significantly increased (RR = 1.09; 95%CI: 1.01- 1.17, P = 0.03); the PR rate (RR = 1.13; 95%CI: 0.97-1.30, P = 0.12); the SD rate (RR = 0.82; 95%CI: 0.64-1.05, P = 0.12); and the 6-month survival rate (RR = 1.05; 95%CI: 1.00-1.10, P = 0.07). There was no significant difference (P &lt; 0.05). CONCLUSION Compared with those of iodized oil TACE, the drug-loaded microspheres tended to have therapeutic advantages.

Clinical and epidemiological profile of blood donors at Montes Claros Regional Blood Center, Southeastern Brazil

Objective: This study aims to analyze blood donation candidates' clinical and epidemiological profiles in Northern Minas Gerais, Brazil, from 2019 to 2022. Methods: We retrospectively searched clinical and epidemiological profiles in the donor data from Montes Claros’ Hemotherapy Center/ Hemominas Foundation from January 2019 to December 2022. Clinical and epidemiological variables were assessed using a blood bank database. Main Results: Of the 81,195 donation candidates, the majority were female, over 29 years old, repeat donors, and replacement donations. Among them, 18.96% were deemed ineligible, with the majority being female, over 29 years old, repeat donors, and replacement donations. Key causes of ineligibility included STD-risk behavior, anemia, hypertension, and Chagas disease. Women showed higher rates of anemia, hypotension, and Chagas disease, while men had more STD-risk behavior, hypertension, alcoholism, and drug use. Among eligible donors, 2.43% had serological ineligibility, notably for hepatitis B, syphilis, and hepatitis C. Conclusion: The frequency of female and repeat donors in Montes Claros was higher than the national average, with disparities in ineligibility between genders and a possible higher prevalence of syphilis and Chagas disease in the local population.

Dynamics and optimal control of a stochastic delayed human papillomavirus epidemic model with media coverage

In this work, we propose a stochastic Human Papillomavirus (HPV) epidemic model with two kinds of delays and media influences. These two time delays are the delay time caused by media receiving the disease information and the delay time of public feedback after the media coverage. In addition, media coverage not only has a negative impact on the infection rate, but it also has a positive impact on the vaccination rate of disease. We discuss the existence and uniqueness of the positive solution for the HPV epidemic model, and then put forward a positively invariant set. The sufficient conditions of the extinction and persistence for the HPV epidemic are given. For the optimal control problem of the HPV epidemic, we obtain an optimal strategy. Our numerical simulations validate the theoretical results of this paper, showing that appropriate media coverage can help control the development of the disease.

The level of thyroid stimulating hormones in different gender and age and the association with the risk of coronary heart disease in cohort population

Objective: To analyze the thyroid stimulating hormone (TSH) levels in different genders and ages, and the association between TSH level and the risk of coronary heart disease. Methods: The baseline survey was conducted using a multi-stage cluster random sampling method from September to December 2015, in Jurong City, Jiangsu Province. A total of 10 703 participants were included in the analysis. The proportion of participants with abnormally elevated TSH defined by three cut-off values (4.5, 7.0, and 10.0 mU/L) were calculated. The cohort was followed up until August 2023 to collect and verify new cases of coronary heart disease. The population was divided into age-and gender-specific quintile subgroups based on TSH. Multivariate Cox regression analysis was used to examine the relationship between TSH and the risk of coronary heart disease. Results: The median age was [M (Q1, Q3)] 61.1(51.8, 67.9) years-old, and there were 4 168 males (38.94%) in the study. The proportions of participants with abnormally increased TSH rose with aging in different genders, and was higher in females than in males (all Ptrend0.05). A total of 206 participants with coronary heart disease at baseline were excluded, and the other 10 497 were followed up for an average of (7.33±1.49) years, during which 350 new cases of coronary heart disease occurred, and the cumulative incidence rate was 3.34%. The cumulative incidence rates among TSH quintile Q1-Q5 groups were 3.62%, 3.32%, 3.56%, 3.28% and 2.57% respectively. Multivariate Cox regression analysis indicated that compared with TSH Q1 group, participants in Q5 group had a lowest risk of coronary heart disease (HR=0.704, 95%CI: 0.498-0.994). The TSH Q5 group was associated with a reduced risk of coronary heart disease in individuals60 years old (HR=0.484, 95%CI: 0.243-0.965), and the risk of coronary heart disease decreased as TSH levels increased (Ptrend=0.008). Conclusions: TSH level increases with aging, and is higher in females than in males. In individuals 60 years old, higher levels of TSH may assaciate with a lower incidence rate of coronary heart disease.

Diagnostic Value of Endobronchial Ultrasound-Guided Intranodal Forceps Biopsies Combined with Rapid On-Site Evaluation for Mediastinal/Hilar Lymph Node Disease

Aims/Background Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is the standard method for sampling mediastinal/hilar lymph node disease. However, the smaller samples obtained via needle aspiration have a lower diagnostic rate for benign compared to malignant diseases. The low diagnostic rates have been reported to be improved through using endobronchial ultrasound-guided intranodal forceps biopsy (EBUS-IFB), but the implementation of IFB presents technical challenges, as described with variable results in certain studies. The main objective of this study was to investigate the diagnostic value and safety of EBUS-IFB for mediastinal/hilar lymph node disease. Methods A retrospective analysis was conducted on 150 patients with mediastinal/hilar lymph node disease at Tianjin Medical University General Hospital. EBUS-TBNA was performed using a rigid bronchoscope on the same lymph node of each patient under general anesthesia, with rapid on-site evaluation (ROSE) conducted to determine the presence of pathological tissue. Following this, a tunnel was established, and a 1.5 mm biopsy forceps was employed for EBUS-IFB. Subsequently, diagnostic rates and safety of the methods used were determined. Results EBUS-IFB + EBUS-TBNA (the combined strategy) exhibited the highest diagnostic rates, with the addition of bronchial mucosa biopsy/transbronchial lung biopsy/neoplasm biopsy contributing to a successful diagnostic rate of 97.2% (139/143). The combined strategy (90.2%) and EBUS-IFB alone (88.1%) contributed to successful diagnosis for all diseases, with rates significantly higher than that of EBUS-TBNA (60.1%) (p &lt; 0.001). The diagnostic rates for malignant disease detected with the combined strategy (97.4%) and EBUS-IFB alone (93.6%) were significantly higher than that with EBUS-TBNA alone (71.8%) (p &lt; 0.001). Both the diagnostic rates for sarcoidosis detected with the combined strategy and EBUS-IFB alone were 87.8%, which was significantly higher than that with EBUS-TBNA alone (46.9%) (p &lt; 0.001). The procedures implemented did not engender major complications. Conclusion Routine EBUS-TBNA followed by ROSE to acquire pathological tissue, followed by tunnel formation and EBUS-IFB, can enhance the overall diagnostic rate for mediastinal/hilar lymph node lesions. This approach is particularly valuable for diagnosing malignant diseases and sarcoidosis. EBUS-IFB serves as a safe and feasible complement to EBUS-TBNA, despite the fact that the procedure was extended in duration.

Using framing and nudging to increase COVID-19 vaccine willingness: An experimental study

Many people are hesitant or unwilling to take advantage of potentially life-saving vaccines; this is true even in a global pandemic and even when vaccines are readily available and/or free. Apart from general unwillingness to be vaccinated, fear of side effects is a frequently named reason for vaccine hesitation. This survey-based study, carried out online in Austria in March of 2021, examines the efficacy of two different approaches – framing and nudging – in promoting a fictional COVID-19 vaccine program. While nudging had no visible effects, either positive or negative, framing was associated with more positive feelings toward the campaign and a greater intention to be vaccinated, though only among those already pre-disposed to get the vaccine. Governments and healthcare organizations are eager to find low-cost measures to increase vaccination rates for COVID-19 and other diseases. This study’s results suggest that addressing and positively framing the high likelihood of problem-free vaccinations should form an integral part of public messages, but that this approach may be ineffective among those who are strongly hesitant or unwilling. AcknowledgementSupported by funds from the province of Tyrol.

The eye movement and gait variability analysis in Chinese patients with Huntington's disease.

Huntington's disease disease (HD) is characterized by motor, cognitive, and neuropsychiatric symptoms. Oculomotor impairments and gait variability have been independently considered as potential markers in HD. But there lacks an integration analysis of eye movement and gait. We assessed multiple examinations of eye movement and gait variability in HTT mutation carriers, analyzed the consistency between these parameters and clinical severity, then examined the association between oculomotor impairments and gait deficits. Seven pre-HD, 30 HD patients and 30 age-matched controls were included. We collected demographics and assessed the Unified Huntington's Disease Rating Scale (UHDRS). Examinations including saccade, smooth pursuit and optokinetic (OPK) test were performed to evaluate eye movement function. The parameters of gait include stride length, walking velocity, step deviation, step length and gait phase. There are significant impairments in HD patients in the latency and velocity of saccades, the gain of smooth pursuit as well as the gain and slow phase velocities (SPV) of OPK tests. Only the speed of saccades has significant difference between pre-HD and controls. There are significant impairments of stride length, walking velocity, step length and gait phase in HD patients. Parameters of eye movement and gait variability in HD patients showed consistency with the scores of UHDRS. There were significant correlations between eye movement and gait parameters. Our results show that eye movement and gait are impaired in HD patients, and speed of saccades is early impaired in pre-HD. Eye movement and gait abnormalities in HD are significantly correlated with clinical disease severities.

Assessment of the Relationship Between Amino Acid Status and Parkinson's Disease: A Comprehensive Review and Meta-analysis.

Parkinson's disease (PD) is characterized by the inability of dopamine production from amino acids. Therefore, changes in amino acid profile in PD patients are very critical for understanding disease development. Determination of amino acid levels in PD patients with a cumulative approach may enlighten the disease pathophysiology. A systematic search was performed until February 2023, resulting in 733 articles in PubMed, Web of Science and Scopus databases to evaluate the serum amino acid profile of PD patients. Relevant articles in English with mean/standard deviation values of serum amino acid levels of patients and their healthy controls were included in the meta-analysis. Our results suggest that valine, proline, ornithine and homocysteine levels were increased, while aspartate, citrulline, lysine and serine levels were significantly decreased in PD patients compared to healthy controls. Homocysteine showed positive correlations with glutamate and ornithine levels. We also analyzed the disease stage parameters: Unified Parkinson's Disease Rating Scale III (UPDRS III) score, Hoehn-Yahr Stage Score, disease duration and levodopa equivalent daily dose (LEDD) of patients. It was observed that LEDD has a negative correlation with arginine levels in patients. UPDRS III score is negatively correlated with phenylalanine levels, and it also tends to show a negative correlation with tyrosine levels. Disease duration tends to be negatively correlated with citrulline levels in PD patients. This cumulative analysis shows evidence of the relation between the mechanisms underlying amino acid metabolism in PD, which may have a great impact on disease development and new therapeutic strategies.

Long-Term Real-World Experience with Safinamide in Patients with Parkinson’s Disease

Introduction: Randomized clinical trials should be complemented with data from real-world studies. We report our long-term experience with safinamide in a movement disorders unit. Methods: This retrospective study included patients with Parkinson’s disease (PD) treated with safinamide in our unit from February 2016 to May 2022 under routine clinical practice. Assessments included the Hoehn and Yahr (HY) stage, unified Parkinson’s disease rating scale (UPDRS) part III score, levodopa equivalent daily dose (LEDD), LEDD for dopamine agonists, and safinamide treatment discontinuation. Results: We included 180 patients with a median age of 74 years (IQR 11), and the majority (90.6%) had an HY stage of ≤2. After a median follow-up of 40 months (IQR 34), 14 patients discontinued treatment with safinamide (7.8%, 95% CI 4.7 to 12.6). Among the 166 patients who remained on safinamide, the UPDRS III score was stable (10 (IQR 9) vs. 9 (IQR 13), p = 0.455). The LEDD significantly increased from a median of 300 mg to 500 mg (p &lt; 0.001), whereas the LEDD for dopamine agonists did not significantly increase. A subgroup of 89 patients who did not require dopamine agonists during follow-up showed stable UPDRS III score (10 (IQR 7) vs. 9 (IQR 14); p = 0.923), with a significant LEDD increase (300 mg to 400 mg, p &lt; 0.001). Conclusions: Our results support the long-term effectiveness and tolerability of safinamide in patients with PD in clinical practice.