Adult Disease Research Articles

Changes in Cerebral Hemodynamics and Progression of Subclinical Vascular Brain Disease: A Population-Based Cohort Study.

Cerebral hypoperfusion is associated with vascular brain injury and neurodegeneration, but their longitudinal relationship is largely unknown, especially in healthy older adults. We investigated the longitudinal relationship between cerebral hemodynamics and subclinical vascular brain disease in community-dwelling older adults without stroke or dementia at baseline. Participants underwent brain magnetic resonance imaging scans every 3 to 4 years between 2005 and 2016. Cerebral blood flow (CBF) was measured through 2-dimensional phase-contrast magnetic resonance imaging; the cerebrovascular resistance index (CVRi) was defined as the ratio of mean arterial blood pressure to total CBF. Simultaneous progression in subclinical brain disease was evaluated through repeated magnetic resonance imaging assessment of white matter hyperintensities (WMH), cerebral microbleeds, lacune, and brain atrophy. The longitudinal relationship was estimated using generalized estimating equations, with adjustment for age, sex, smoking habits, body mass index, systolic blood pressure (for CBF measures), lipid level, history of diabetes and cardiovascular disease, and the baseline burden of magnetic resonance imaging markers. Among 3623 older adults (mean age, 61.4±9.3 years; 54.6% women), large decreases and increases in CBF and increases in CVRi over time were associated with white matter hyperintensity progression. The risk ratios for white matter hyperintensity progression were 1.36 (95% CI, 1.19-1.55) for large decreases in total CBF (lowest quartile), 1.02 (95% CI, 0.91-1.14) for moderate decreases (second quartile), and 1.28 (95% CI, 1.14-1.45) for large increases (highest quartile), compared with stable CBF (third quartile). The corresponding risk ratios for changes in CVRi were 1.13 (95% CI, 1.00-1.30), 1.25 (95% CI, 1.09-1.43), and 1.33 (95% CI, 1.16-1.52) for the second to fourth (versus lowest) quartiles, respectively, showing a dose-response relationship. The changes in CBF also demonstrate a similar U-shaped association with the progression of brain atrophy and incident microbleeds, whereas increases in CVRi were associated with lower microbleed risk. Longitudinal changes in CBF and CVRi may capture distinct pathophysiologies linking cerebral hemodynamics to subclinical brain disease, extending beyond single-time point measurements.

Invasive pneumococcal disease in adults after the introduction of pneumococcal vaccination: a retrospective study in the metropolitan area of Zagreb, Croatia (2010–2022)

Invasive pneumococcal disease in adults after the introduction of pneumococcal vaccination: a retrospective study in the metropolitan area of Zagreb, Croatia (2010–2022)

Correlation between plasma homocysteine and ischemic heart disease in young Adults

Correlation between plasma homocysteine and ischemic heart disease in young Adults

Cross-sectional analysis of non-HDL/HDL cholesterol ratio as a marker for cardiovascular disease risk in middle-aged and older adults: Evidence from the CHARLS study

While cardiovascular disease is linked to abnormal lipid metabolism, the relationship between NHHR (non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio), a new lipid metric, and cardiovascular disease in middle-aged and older adults in China is still unclear. This cohort study, based on a population sample, examined the incidence of cardiovascular disease (CVD) events, including stroke and heart disease. It utilized self-reported diagnoses from the study's inception and during Wave 4, involving 9259 participants from the China Health and Retirement Longitudinal Study (CHARLS). The research employed restricted cubic spline models and multivariate logistic regression to investigate possible non-linear relationships. Additionally, subgroup analyses were conducted to assess the influence of socio-demographic factors on the outcomes. During the seven-year follow-up period, 1,139 participants developed CVD, including 742 cases of heart problems and 582 strokes. In Model 3, it was observed that for each unit increase in the highest NHHR group, the risk of developing CVD increased by 98%, the risk of stroke increased by 48%, and the risk of heart problems increased by 115%. Subgroup analyses indicated that this correlation was more pronounced among individuals under 60 years of age and those with hypertension. According to the current study, elevated NHHR ratio is an important risk factor for CVD in middle-aged and elderly Chinese. Early intervention in patients with higher NHHR ratios may help to further reduce the incidence of CVD.

Role of scalp arteries in revascularization after side to side anastomosis in moyamoya disease patients

In our recent study, we introduced a novel side-to-side (S-S) bypass technique for adult moyamoya disease (MMD) patients. We aimed to validate the potential of this technique in enhancing postoperative revascularization. Patients undergoing S-S or end-to-side (E-S) bypass were enrolled, clinical data and angiography parameters were collected and compared. We included 44 E-S and 40 S-S MMD patients. There were no significant differences in basic characteristics and postoperative Matsushima grades between the two groups. However, in the S-S group, fewer patients had Matsushima grade D (0%) compared to the E-S group (11.4%, P = 0.028). The S-S group showed a greater occipital artery (OA) participation in revascularization (87.5% vs. 56.8%, P = 0.002) and higher postoperative caliber change ratio (CCR) of the superficial temporal artery (STA)-frontal branch (1.26 ± 0.43 vs. 1.04 ± 0.53, P = 0.038) compared to the E-S group. This difference was more pronounced in the subgroup with poor revascularization outcomes: in the S-S group, the CCR of the STA-frontal branch and the degree of participation in revascularization were 1.163 ± 0.168 and 58.8%, respectively, while in the E-S group, they were only 0.798 ± 0.494 and 6.7%. The S-S group also had a higher OA CCR (1.133 ± 0.257) and participation (82.4%) compared to the E-S group (0.941 ± 0.216 and 37.5%, respectively). In conclusion, the S-S bypass technique effectively utilizes scalp arteries, particularly the STA-frontal branch and OA, for direct revascularization via the preserved distal STA in adult MMD patients. Scalp arteries can serve as a supplementary source of donor arteries, especially beneficial for patients with suboptimal revascularization outcomes.

Association between self-reported child maltreatment and risk of hospital-treated infectious diseases in middle-aged and older adults: A UK Biobank cohort study.

This study aimed to explore the association between child maltreatment and hospital-treated infectious diseases in middle-aged and older adults. 145,151 participants aged 38-72 years from the UK Biobank between 2006 and 2010 were enrolled and interviewed. Child maltreatment included five types: physical abuse, physical neglect, emotional abuse, emotional neglect, and sexual abuse. Patterns of maltreatment were identified using latent class analysis (LCA). Cox regression was employed to estimate the associations between child maltreatment (number of types, individual types, and patterns) and infectious diseases. Further, we evaluated potential mediators using mediation analysis. Over a median follow-up of 13.4 years, 22,688 participants (12.26 per 1000 person-years) were hospitalized for an infectious disease. Participants reporting any maltreatment had elevated infectious diseases risk (HR 1.18, 95 % CI: 1.15-1.21) than those without maltreatment. A dose-response relationship was observed between the number of maltreatment types and infectious disease (one, HR 1.09 [95 % CI 1.06-1.13]; two, HR 1.17 [95 % CI 1.12-1.23]; three to five, HR 1.48 [95 %CI 1.41-1.55]; Ptrend < 0.001). Each type of maltreatment was associated with increased infectious diseases risk. LCA identified four patterns (low maltreatment, child neglect, child abuse, and poly-maltreatment), with those experiencing poly-maltreatment exhibiting the highest infectious diseases risk (HR 1.51, 95 % CI: 1.43-1.59). The association between child maltreatment and infectious diseases was mediated by C-reactive protein, phenotypic age acceleration, loneliness, psychiatric disorders, and unhealthy lifestyles. Child maltreatment may increase susceptibility to a broad spectrum of infectious diseases in adulthood, highlighting the need for early-life maltreatment prevention policies.

The effects of mosaicism on biological and clinical markers of Alzheimer's disease in adults with Down syndrome

Individuals with Down syndrome (DS) are at high risk of early-onset Alzheimer's disease (AD); yet, some 20 percent do not develop any signs of dementia until after 65 years or in their lifetime. Mosaicism could contribute to this phenotypic variation, where some disomic cells could lead to lower levels of gene products from chromosome21. We examined longitudinal neuropsychological and biomarker data from two large studies of DS: the Alzheimer Biomarker Consortium-Down syndrome study (ABC-DS) (n=357); and a legacy study (n=468). We assessed mosaicism using karyotyping or GWAS data. Participants had data on plasma AD biomarkers (Aβ40, Aβ42, tau, and NfL) and longitudinal cognitive measures. A subset had cerebrospinal fluid biomarkers (Aβ40, Aβ42, tau, ptau181, and NfL) and amyloid and tau PET data. For both cohorts, the prevalence of mosaicism was <10% (ABC-DS: 7.3%; Legacy: 9.6%), and those with mosaicism had lower plasma Aβ40 and Aβ42 concentrations. For the older legacy cohort, when compared to those with full trisomy, those with mosaicism had significantly smaller decline in total and annualized neurocognitive scores, and lower incidence and prevalence of dementia. Mosaicism in DS was associated with lower concentrations of plasma Aβ peptides, possibly leading to lower AD risk. However, its clinical impact was less clear in the younger ABC-DC cohort, and a follow-up study is warranted. National Institutes of Health (R01AG014673, P01HD035897, R56AG061837), NIA (U01AG051412, U19AG068054), NICHD, ADRC programs, the Eunice Kennedy Shriver Intellectual and Developmental Disabilities Research Centers Program, and NCATS (UL1TR001873).

Associations between eicosapentaenoic acid and docosahexaenoic acid consumption and inflammatory bowel disease in adults: The National Health and Nutrition Examination Survey (NHANES) 2009-2010.

Current evidence on the associations of dietary eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) consumption with the risk of inflammatory bowel disease (IBD) is inconsistent. This study aimed to investigate the relationship between dietary EPA and DHA consumption with the incidence of IBD in a population of the United States, which potentially provides insights for global nutritional prevention and control strategies for IBD. Data were sourced from the National Health and Nutrition Examination Survey for the years 2009-2010. EPA and DHA consumption was measured using twice 24-h dietary recall questionnaires. In the arthritis questionnaire, the incidence of IBD was inquired via a sub-analysis for arthropathy. To assess the relationship between dietary EPA and DHA consumption with the incidence of IBD, binary logistic regression and limited cubic spline models were used. A total of 4,242 individuals aged 20 years and older participated in this survey. IBD was diagnosed in 52 individuals, representing a prevalence of 1.23%. The 95% confidence interval for crude odds ratios (ORs) of IBD in quartiles 2 and 3 of dietary EPA consumption was 0.14 (0.04-0.55) (p<0.05) and 0.36 (0.18-0.73) (p<0.05) when compared to quartile 1, respectively. The 95% confidence interval for crude ORs of IBD in quartile 4 of dietary DHA consumption was 0.09(0.02-0.35) (p<0.05) when compared to quartile 1. For the National Health and Nutrition Examination Survey in 2009-2010, increased dietary EPA and DHA consumption may be related to a decreased risk of IBD in Americans aged 20 and above.

Fasting intact insulin by mass spectrometry is associated with metabolic dysfunction-associated steatotic liver disease in youth.

Fasting intact insulin concentrations can predict metabolic dysfunction-associated steatotic liver disease (MASLD) in adults without diabetes; however, research in youth is limited. We sought to determine whether fasting intact insulin, measured by liquid chromatography-tandem mass spectrometry, is associated with MASLD in children. This retrospective cross-sectional analysis used data and samples from children who participated in studies across 3 universities between 2014 and 2022. Key measurements included fasting intact insulin, ALT, and hepatic steatosis assessed by MRI techniques. MASLD was defined as hepatic steatosis ≥5% by MRI with at least 1 cardiometabolic risk factor. The optimal cutoff points to identify MASLD were determined by maximizing the Youden index, and the AUROC curves were compared using the DeLong test. The analysis included 184 children (28% male; 14.9 ± 2.6y; 57% Hispanic race/ethnicity; body mass index 32.5 ± 8.1kg/m2; 64% with MASLD, 43% with polycystic ovary syndrome, and 5% with other liver diseases). Fasting intact insulin and ALT levels were significantly higher in children with MASLD (p < 0.05). Fasting intact insulin was strongly associated with MASLD with an AUROC of 0.83 (0.77-0.90), sensitivity of 71%, and specificity of 85%. When combined with ALT (intact insulin × ALT [μU/mL × U/L]), the AUROC was 0.88 (0.83-0.94), with a sensitivity of 89% and specificity of 81%. The improvement in AUROC over intact insulin alone was not statistically significant (p = 0.089) but was statistically significant from ALT (p = 0.022). Optimal cutoff points for intact insulin and intact insulin × ALT were 20μU/mL and 522μU/mL × U/L, respectively. In pediatric patients, measurements of fasting intact insulin alone and combined with ALT provide a noninvasive strategy for identifying the presence of MASLD.

Long-term weight change, incident cardiovascular disease and all-cause mortality among diabetic adults

We aimed to explore the impact of weight change from young to middle adulthood on incident cardiovascular disease (CVD) and all-cause mortality in US diabetic adults. All study subjects aged 40–79 years were from the US National Health and Nutrition Examination Survey (NHANES) 1988–2018, and they were non-pregnant and had complete data on self-reported weight at age 25 and 10 years before baseline enrollment over average 29.4 years. CVD events occurring from 10 years ago to baseline enrollment were recorded. Relative to stable non-obesity group, the strongest association was noted for the weight-losing group, followed by the stable-obesity group and weight-gaining group over following 10 years. Referring to the stable-obesity group identified significance for the stable non-obesity group. If total population had maintained non-obese from young to middle adulthood, 12 % of CVD cases could have been averted. Relative to the stable non-obesity group, subjects who maintained obese between young and middle adulthood had an increased risk of all-cause mortality. Our findings indicated that the risk for incident CVD and all-cause mortality was potentially reinforced in diabetic adults who were obese at age 25 but non-obese at midlife and who remained stable obese vis-à-vis those with stable non-obesity.

A comprehensive analysis of demographics, comorbidities, and laboratory findings in adult celiac disease patients: a single center experience

Aims: This study aims to evaluate the demographics, comorbidities, and laboratory findings of patients with celiac disease in our clinic. Methods: A total of 91 celiac patients who were followed in our centre between January 2020 and September 2023 were included in the study. Demographic, laboratory and comorbidities data were analysed retrospectively. Results: 72 (79.1%) patients were female, and the mean age of the participants was 42.3 (+-) 15.1 years. Deficiency of iron was observed in 46 (50.6%) participants, vitamin B12 in 9 (9.9%) participants, folat in 11 (12.1%) participants, and vitamin D in 37 (40.7%) participants. Hypothyroidism and diabetes mellitus were found to be the two most common comorbidities of celiac disease. In addition, liver enzymes were demonstrated to be elevated in the 9 (9.9%) patients. Conclusion: Celiac disease is associated with mineral and vitamine deficiency. In addition, mildly elevated liver enzymes may be observed in the clinical course. Notably, extraintestinal manifestations, especially hypothyroidism and diabetes, may accompany the disease.

Association of the atherogenic index of plasma and modified triglyceride-glucose indices with digestive diseases among middle-aged and older population in China

BackgroundPrevious studies have shown that metabolic imbalances contribute to digestive diseases. This study aimed to investigate the relationship of the atherogenic index of plasma (AIP) and modified triglyceride-glucose (TyG) indices with digestive diseases.MethodsWe recruited participants aged 45 years or older from the China Health and Retirement Longitudinal Study (CHARLS, 2011 − 2020). The indices assessed included AIP, TyG, triacylglycerol glucose-waist circumference (TyG-WC), the triacylglycerol glucose-waist-to-height ratio (TyG-WHtR), and the triacylglycerol glucose-body mass index (TyG-BMI). We used logistic regression and restricted cubic spline (RCS) analyses to examine the associations between these indices and the incidence of digestive diseases.ResultsA total of 4,453 participants were included in our analysis, 53.3% of whom were female, with an average age of 60 years. The incidence of digestive diseases in middle-aged and older adults was 6.18%. Compared with those in the lowest tertile group, the odds ratios (ORs) with 95% confidence intervals (CIs) for digestive diseases in the highest tertile for AIP, TyG, TyG-WC, TyG-WHtR, and TyG-BMI were 1.452 (1.07–1.972), 1.193 (0.873–1.631), 1.349 (1.044–1.743), 1.5 (1.089–2.068), and 1.312 (0.956–1.799), respectively. Sensitivity analyses confirmed the robustness of the correlations between these indices and digestive diseases.ConclusionOur study revealed that the AIP, TyG-WC, and TyG-WHtR were independently associated with the incidence of digestive diseases. These findings highlight the importance of considering and optimizing metabolic factors in management strategies for digestive diseases.

Cardiovascular Disease & Diabetes Statistics in Korea: Nationwide Data 2010 to 2019.

This study aimed to provide updated insights into the incidence and management of cardiovascular disease (CVD) in Korean adults with diabetes. Using data from the Korean National Health Insurance Service and Korea National Health and Nutrition Examination Survey, we analyzed the representative national estimates of CVD in adults with diabetes. The age- and sex-standardized incidence rate of ischemic heart disease (IHD), ischemic stroke, and peripheral artery disease (PAD) decreased from 2010 to 2019 in individuals with type 2 diabetes mellitus (T2DM). However, an increase in the incidence of heart failure (HF) was observed during the same period. Only 4.96% of adults with diabetes and CVD achieved optimal control of all three risk factors (glycemic levels, blood pressure, and lipid control). Additionally, high-intensity statin treatment rates were 8.84% and 9.15% in individuals with IHD and ischemic stroke, respectively. Treatment with a sodium-glucose cotransporter-2 inhibitor (SGLT2i) or a glucagon-like peptide-1 receptor agonist (GLP-1RA) was relatively low in 2019, with only 11.87%, 7.10%, and 11.05% of individuals with IHD, ischemic stroke, and HF, respectively, receiving SGLT2i treatment. Furthermore, only 1.08%, 0.79%, and 1.06% of patients with IHD, ischemic stroke, and HF, respectively, were treated with GLP-1RA. The incidence of most CVD (IHD, ischemic stroke, and PAD) decreased between 2010 and 2019, whereas the incidence of HF increased. The overall use of high-intensity statins, SGLT2i, and GLP-1RA remained low among individuals with T2DM and CVD.

Prevalence and diversity of retinal disease in adults with Down syndrome.

While epidemiologic data exists for some ophthalmic diseases in people with Down Syndrome (DS), like strabismus and amblyopia, no studies explore the prevalence of retinal disease in people with DS on a large scale. This study utilized a literature review and exploratory epidemiology analysis to examine patterns of retinal disease in people with DS. To evaluate previous studies on physiology and/or anatomy in retinal models representing DS or in the retinas of people with DS, all relevant terms related to Down Syndrome, retina, and retinal diseases were searched in PubMed and Scopus. Data from the health platform TriNetX was then utilized to determine the prevalence and prevalence odds ratio (POR) of retinal disorders, including diabetic retinopathy and age-related macular degeneration (AMD), within the U.S. adult population with DS. The final literature review included 28 of 535 screened studies and found that a DS diagnosis was associated with atypical retinal vascularization, retinal thickening, and abnormal neuronal development. Of 55,198,979 individuals included in the population study, 97,795 (0.18%) had a recorded DS diagnosis. Compared to the population without DS, the population with DS had significantly increased PORs for any retinal diagnosis (3.78, 95% CI 3.63-3.93), for 16 of 18 recorded individual retinal diagnoses, and for 4 of 5 major diagnostic categories, including diabetic retinopathy (2.56, 95% CI 2.33-2.82) and macular degeneration (4.01, 95% CI 3.42-4.71). The conclusion is that retinal anomalies common to people with DS likely contribute to higher rates of recorded retinal disease. However, future studies should evaluate this relationship.

The association between plasma levels of Sestrin2 and risk factors of cardiovascular diseases in healthy and diabetic adults: A study of Qatar Biobank data

The association between plasma levels of Sestrin2 and risk factors of cardiovascular diseases in healthy and diabetic adults: A study of Qatar Biobank data

Obesity with low bone mineral density is a risk for cerebral small-vessel disease in older adults: The Bunkyo Health Study

BackgroundCerebral small-vessel disease (cSVD), a key risk factor for stroke and dementia, has been linked to obesity and low bone mineral density (BMD). While obesity and low BMD are often inversely related, their coexistence may increase cSVD risk. We aimed to assess the prevalence of obesity and low BMD coexistence and its association with increased cSVD prevalence. MethodsThis cross-sectional study used baseline data from the Bunkyo Health Study, which included 1531 community-dwelling adults aged 65–84 years without prior stroke history. All participants underwent dual-energy X-ray absorptiometry and brain magnetic resonance imaging. We defined cSVD as the presence of cerebral lacunar infarcts, cerebral microbleeds, periventricular hyperintensity or deep white matter hyperintensity. Obesity was defined by body mass index. Low BMD was defined as osteoporosis in women and osteopenia/osteoporosis in men. Participants were stratified by sex and classified based on obesity and low BMD presence or absence. ResultsThe prevalence of obesity with low BMD was 8.0 % in women and 7.8 % in men. The overall prevalence of cSVD was 23.2 %. Logistic regression analysis revealed that compared to the non-obese and non-low BMD group, the ORs [95 % CIs] for cSVD in the low BMD group, obesity group, and obesity with low BMD group were 1.55 [1.01–2.38], 1.24 [0.66–2.32], and 2.33 [1.20–4.50] in women, and 0.96 [0.60–1.54], 1.13 [0.65–1.96], and 2.80 [1.38–5.69] in men, respectively. ConclusionThe coexistence of obesity and low BMD, observed in approximately 8 % of older adults, was independently associated with the presence of cSVD.

Maternal polycystic ovary syndrome and Offspring’s Risk of Cardiovascular diseases in Childhood and Young Adulthood

Children born to mothers with polycystic ovary syndrome have a higher prevalence of cardiovascular risk factors and of subclinical cardiovascular disease, but the association between maternal polycystic ovary syndrome and cardiovascular disease in offspring is unclear. We conduct a register-based cohort study of 6 839 703 live singleton births from Denmark (1973–2016) and Sweden (1973–2014) and follow them for up to 48 years. Using Cox regression models, we find that offspring of mothers with polycystic ovary syndrome have a higher risk of overall cardiovascular diseases and of its specific subtypes, independently of comorbidities related to polycystic ovary syndrome. Cousin analyzes suggest that familial confounding does not explain our results. If our findings are replicated by future studies, children of women with polycystic ovary syndrome may benefit from early cardiovascular prevention efforts.

Hypoplastic left heart syndrome (HLHS) becomes of age: Assessing the young adult with HLHS including the neoaorta/aortic arch

Hypoplastic left heart syndrome (HLHS) is one of the most complex congenital heart defects (CHD), characterized by a hypoplastic left ventricle (LV), dominant right ventricle (RV) and small left-sided heart structures. The introduction of the Norwood operation has significantly improved outcomes, with 5-year survival reported up to 65 %. Despite these advances, post-operative morbidity and mortality remain high, and the long-term complications in adult survivors represent a challenge. The number of HLHS patients with Fontan circulation is expected to double in the next 20 years, leading to a growing population requiring specialized care from adult congenital heart disease (ACHD) teams.This article reviews current management strategies for HLHS, outlines potential long-term complications, and highlights existing knowledge gaps. Specific considerations in this population include the assessment of the neo-aorta and aortic arch, and systemic RV dysfunction in the setting of a Fontan circulation. The proposed surveillance strategy emphasizes the need for vigilant monitoring and timely intervention to treat the complications unique to this population, ensuring better outcomes for HLHS patients reaching adulthood.

Expanded application of unilateral biportal endoscopy in adult thoracic disease: report of three cases and literature review.

Traditional surgery for degenerative thoracic disorder can be extremely invasive and accompanied by complications. Unilateral biportal endoscopy (UBE), a newly developed technique in the field of spin surgery, is minimally invasive and its popularity and indications have been increasing. In this study, we report three cases of different thoracic diseases treated using UBE. The first case was a 50-year-old male patient with lower extremity tingling sense and right thigh anterior aspect radiating pain. Bilateral decompression and removal of ossification of the ligamentum flavum (OFL) was done. The second case was a 75-year-old female who had symptoms of gait disturbance and motor weakness due to thoracic myelopathy in T12-L1. We performed canal decompression and discectomy using the far-lateral approach. The third case was a 69-year-old female with poor medical condition due to lymphoma who had symptoms of right intercostal pain that occurred after T12 acute compression fracture. UBE treatment was decided, and nerve decompression was performed. In the first case, the tingling sense due to OYL improved three months after the surgery. In the second case, the right lower extremity radiating pain and gait disturbance showed improvement after surgery, but motor weakness continued until four months after surgery. In the third case, intercostal pain showed improvement immediately after surgery. Although UBE surgery is limited in completely replacing traditional treatments for degenerative thoracic disease, it offers the advantages of rapid rehabilitation and short-term hospitalization and can be a good surgical treatment option.

Association between waist circumference or weight change after smoking cessation and incidence of cardiovascular disease or all-cause death in Korean adults with type 2 diabetes

Association between waist circumference or weight change after smoking cessation and incidence of cardiovascular disease or all-cause death in Korean adults with type 2 diabetes