High Risk Research Articles

Search for germline gene variants in colorectal cancer families presenting with multiple primary colorectal cancers.

A double primary colorectal cancer (CRC) in a familial setting signals a high risk of CRC. In order to identify novel CRC susceptibility genes, we whole-exome sequenced germline DNA from nine persons with a double primary CRC and a family history of CRC. The detected variants were processed by bioinformatics filtering and prioritization, including STRING protein-protein interaction and pathway analysis. A total of 150 missense, 19 stop-gain, 22 frameshift and 13 canonical splice site variants fulfilled our filtering criteria. The STRING analysis identified 20 DNA repair/cell cycle proteins as the main cluster, related to genes CHEK2, EXO1, FAAP24, FANCI, MCPH1, POLL, PRC1, RECQL, RECQL5, RRM2, SHCBP1, SMC2, XRCC1, in addition to CDK18, ENDOV, ZW10 and the known mismatch repair genes. Another STRING network included extracellular matrix genes and TGFβ signaling genes. In the nine whole-exome sequenced patients, eight harbored at least two candidate DNA repair/cell cycle/TGFβ signaling gene variants. The number of families is too small to provide evidence for individual variants but, considering the known role of DNA repair/cell cycle genes in CRC, the clustering of multiple deleterious variants in the present families suggests that these, perhaps jointly, contributed to CRC development in these families.

Traumatic posterior atlantoaxial dislocation without an associated fracture: a PRISMA-compliant case-based systematic review and meta-analysis.

Traumatic posterior atlantoaxial dislocation (TPAD) without an associated fracture is a rare and challenging spinal injury. This PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses)-compliant case-based systematic review and meta-analysis aimed to comprehensively explore TPAD, covering clinical presentation, diagnosis, treatment, and clinical and radiological outcomes. Following the presentation of a case of TPAD without an associated fracture, we conducted a systematic search of electronic databases, including Scopus, PubMed, and Web of Science, from inception through October 2023, without language restrictions. Cases involving dislocations due to congenital anomalies or inflammatory processes were excluded. The search yielded 31 eligible cases of TPAD without an associated fracture. The majority (81%) of the cases were males, with traffic accidents being the leading cause (87%). Notably, 52% of the cases presented without any neurological deficits. Regarding treatment approaches, 23% of the cases were managed through closed reduction alone, 32% required fusion following closed reduction, and 45% underwent open reduction and fusion. A time delay exceeding 7.5 days was associated with a significantly higher risk of closed reduction failure (odds ratio, 56.463; p =0.011). This review identified key management strategies for TRAD without fracture, informed by the available evidence. Optimal management entails prompt closed reduction under C-arm while monitoring neurological status once hemodynamic stability is achieved. Surgical fusion is indicated for cases with magnetic resonance imaging-confirmed transverse ligament rupture or residual instability. If closed reduction fails, open reduction and fusion should be carried out. Posterior C1-C2 screws fixation is the preferred fusion technique, providing high levels of safety and biomechanical stability.

Adverse childhood experiences and subsequent experiences of intimate partner violence in adulthood: a gender perspective.

Investigate the prevalence of adverse childhood experience (ACE) and intimate partner violence (IPV) using a large representative Chinese sample, explore the association mechanism between ACE and adult exposure to IPV and to examine gender differences. A total of 21,154 participants were included in this study. The ACE scale was used to assess participants' exposure to ACE before the age of 18. Participants were evaluated for IPV experienced after the age of 18 using the IPV Scale. Logistic regression model was used to analyse the association between ACE and the risk of IPV exposure in adulthood. Principal component analysis was used to extract the main patterns of ACEs in the Chinese population. Network analyses were employed to identify the most critical types of ACE and IPV, analyse the association mechanisms between ACEs and IPVs, explore gender differences in this association and compare gender differences in the severity of IPVs experienced in adulthood. Participants with at least one ACE event faced a 215.5% higher risk of IPV compared to those without ACE experiences. In population-wide and gender-specific networks, The ACE and IPV nodes with the highest expected influence are 'ACE1 (Verbal abuse + physical abuse pattern)' and 'IPV5 (Partner compares me to other people and blatantly accuses me, making me feel embarrassed and unsure of myself)'. Positive correlations were found between 'ACE1 (Verbal abuse + physical abuse pattern)'-'IPV3 (Partner does not care about me when I am in bad shape [not feeling well or in a bad mood])', 'ACE4 (Violent treatment of mother or stepmother + criminal acts in the family pattern)'-'IPV1 (Partner has ever directly assaulted or hurt me with the help of an instrument)' and 'ACE2 (Exposure to sexual assault pattern)'-'IPV2 (Partner would have physical or sexual contact with me against my will)', which were the three edges with the highest edge weight values in the ACE pattern and IPV edges. 'ACE1 (Verbal abuse + physical abuse pattern)'-'IPV3 (Partner does not care about me when I am in bad shape [not feeling well or in a bad mood])', 'ACE2 (Exposure to sexual assault pattern)'-'IPV2 (Partner would have physical or sexual contact with me against my will)', 'ACE4 (Violent treatment of mother or stepmother + criminal acts in the family pattern)'-'IPV1 (Partner has ever directly assaulted or hurt me with the help of an instrument)' in the male network and 'ACE1 (Verbal abuse + physical abuse pattern)'-'IPV3 (Partner does not care about me when I am in bad shape [not feeling well or in a bad mood])', 'ACE4 (Violent treatment of mother or stepmother + criminal acts in the family pattern)'-'IPV1 (Partner has ever directly assaulted or hurt me with the help of an instrument)', 'ACE3 (Substance abuse + mental illness + violent treatment of mother or stepmother pattern)'-'IPV1 (Partner has ever directly assaulted or hurt me with the help of an instrument)' in the female network are the three edges with the highest edge weights among the ACE and IPV edges in their networks, respectively, all displaying positive correlations. The strength of 'IPV3 (Partner does not care about me when I am in bad shape [not feeling well or in a bad mood])' was higher in the male network than in the female (male = 0.821, female = 0.755, p = 0.002). The edge weight values of 'ACE3 (Substance abuse + mental illness + violent treatment of mother or stepmother pattern)'-'IPV1 (Partner has ever directly assaulted or hurt me with the help of an instrument)' (P = 0.043) and 'ACE4 (Violent treatment of mother or stepmother + criminal acts in the family pattern)'-'IPV1 (Partner has ever directly assaulted or hurt me with the help of an instrument)' (P = 0.032) are greater for females than males. The most common type of ACE in the Chinese population is verbal violence combined with physical violence, while the predominant type of IPV is verbal violence. Males experience higher levels of emotional neglect from their partners compared to females. The association between witnessing physical violence in childhood and experiencing physical violence from a partner in adulthood is stronger in females than in males. The homotypic continuum between ACE and IPV is a crucial mechanism in understanding intergenerational domestic violence. Enhance economic and educational levels, promote correct parenting concepts, reduce child abuse, establish accurate perceptions of intimate relationships, eliminate shame about violence and further advance gender equality. These efforts are vital for reducing IPV prevalence and breaking the cycle of violence in victims' lives.

The Prevalence of Obesity is Increased in Adolescents with Amblyopia: An Analysis of National Health and Nutrition Examination Survey Data.

Background: Amblyopia is the most common cause of vision loss in children. Amblyopia has been associated with impaired depth perception but little attention has been paid to the extent to which amblyopia increases the risk of obesity. Methods: Public-use data from the 1999-2008 National Health and Nutrition Examination Survey were used. Analyses were limited to children aged 12-18, who had a visual examination, and a best corrected visual acuity (BCVA) of at least 20/40 in the better-seeing eye. Amblyopia was defined as two or more-line interocular difference in BCVA. Obesity was defined as Body Mass Index (BMI) or body fat percentage (BFP) ≥95th percentile for age and gender. Sedentary lifestyle was defined as cardiovascular fitness level (CFL) rating of "low." We used Mantel-Haenszel odds ratios (ORs) to examine the relative prevalence of obesity in children with/without amblyopia. Results: Adolescents with amblyopia (n = 360) were more likely than those without (n = 7935) to have a high BMI [OR = 1.56; 95% confidence interval (CI): 1.24-1.98; p < 0.001]. The associations with either high BFP (OR = 1.20; 95% CI: 0.86-1.56, p = 0.167) or low CFL (OR = 1.15; 95% CI: 0.83-1.57; p = 0.267) were not statistically significant but in the direction of a priori hypotheses. Conclusions: This analysis of population-based data suggests that adolescents with amblyopia may be at higher risk of having obesity. Given the high prevalence of amblyopia and the range of morbidities associated with childhood obesity, targeted interventions to reduce the risk of obesity among children with amblyopia could be warranted.

Immunological mechanisms of tuberculosis susceptibility in TB-infected individuals with type 2 diabetes mellitus: insights from mycobacterial growth inhibition assay and cytokine analysis.

This study is important because it sheds light on the impaired immune response in individuals with type 2 diabetes mellitus (T2DM) who are infected with Mycobacterium tuberculosis (M.tb), offering critical insights into why they are at higher risk of developing active tuberculosis (TB). By demonstrating that T2DM individuals exhibit a weakened ability to control M.tb growth and a compromised cytokine profile, the research underscores the need for better diagnostic tools, such as the mycobacterial growth inhibition assay (MGIA), to identify those at greater risk of progression to active TB. The findings also highlight the importance of integrated care strategies for managing both T2DM and TB, particularly in TB-endemic regions, and point to the need for further research to develop more effective interventions tailored to this vulnerable population.

Brachial-Ankle Pulse Wave Velocity as a Predictor of Diabetes Development: Elevated Risk Within Normal Range Values in a Low-Risk Population.

Recent studies have suggested that increased brachial-ankle pulse wave velocity (baPWV) is a risk factor for diabetes. Exploring its relationship with insulin resistance is of interest, necessitating further studies across different sexes and age groups. This cohort study involved 119 170 Korean adults with an average age of 39.8 years, none of whom had diabetes at baseline. As part of a health screening, baPWV measurements were taken. Over a median follow-up period of 5.6 years, fasting blood glucose, glycated hemoglobin, insulin levels, and questionnaire responses were collected. The risk of developing diabetes was evaluated using a flexible parametric proportional hazards model with data stratified by sex and age group (<40 versus ≥40 years). During the follow-up period, diabetes was diagnosed in 5966 participants (5.0%). A fully adjusted model found that the hazard ratios for diabetes onset associated with baPWV quartiles Q2 (1171.0-1270.5 cm/s), Q3 (1271.0-1376.0 cm/s), and Q4 (≥1376.5 cm/s) compared with Q1 (<1171.0 cm/s) were 1.06 (95% CI, 0.96-1.17), 1.25 (1.14-1.38), and 1.48 (1.34-1.62), respectively (P for trend <0.001). A significant sex-based interaction was noted in this association, with women showing a higher risk of diabetes development. Furthermore, higher baPWV quartiles were associated with an increased risk of developing insulin resistance, defined as the homeostatic model assessment of insulin resistance. These findings highlight the importance of arterial stiffness, as measured by elevated baPWV, in the development of diabetes and insulin resistance. Notably, this study highlighted a strong association, particularly among women.

Analysis of association of SP-C gene polymorphisms with Neonatal respiratory distress syndrome

To analyze the association between pulmonary surfactant protein C (SP-C) gene polymorphisms and the risk of Neonatal respiratory distress syndrome (NRDS). Clinical data from 168 neonates diagnosed with NRDS (NRDS group) admitted between August 2020 and June 2023 were collected. Additionally, 168 neonates without respiratory distress, born during the same period, were included as the control group. Peripheral venous blood samples (2 mL each) were collected from both groups. PCR-restriction fragment length polymorphism technique was employed to detect the polymorphisms at the SP-C gene loci p.Thr138Asn (rs4715) and p.Ser186Asn (rs1124). Hardy-Weinberg equilibrium tests were conducted for genotyping, and genotypic and allelic frequencies were compared. The association between SP-C gene polymorphisms and NRDS risk was evaluated. Furthermore, genotypic and allelic frequencies at the rs4715 and rs1124 loci were compared among NRDS cases with varying degrees of disease severity. The study was approved by the Medical Ethics Committee of Shangqiu First People's Hospital (Ethics No. 2020-031). The frequency of the variant allele (A) at the rs4715 locus was significantly higher in the NRDS group compared to the control group (32.14% vs. 24.11%, P = 0.001). The frequency of the variant genotype (AA + AC) was also higher in the NRDS group (47.02% vs. 39.29%, P = 0.043). The frequency of the variant allele (A) at the rs1124 locus was higher in the NRDS group compared to the control group (34.23% vs. 23.51%, P = 0.027), with a higher frequency of the variant genotype (AA + AG) in the NRDS group (49.40% vs. 39.29%, P = 0.019). No significant correlation was observed between the rs4715 polymorphism and the severity of NRDS (P > 0.05). Among NRDS children with grade III severity, the frequency of the variant allele (A) at the rs1124 locus was higher than in grade I and grade II children (47.62% vs. 29.22%, P = 0.020). The frequency of the variant genotype (AA + AG) was also higher in grade III children (64.28% vs. 43.84%, P = 0.040). SP-C gene polymorphisms are associated with the susceptibility to NRDS. Neonates carrying the AA genotype and the A allele at the rs1124 locus are at a higher risk of severe NRDS. These findings have provided further evidence for early screening, diagnosis, and treatment of NRDS.

Association of Visceral Adipose Tissue With Hypertension: Results From the NHANES 2011-2018 and Mendelian Randomization Analyses.

The causal relationship between visceral adipose tissue (VAT) and hypertension remains unclear. We aimed to examine the potential association between them using observational and two-sample Mendelian randomization (MR) analyses. Data from the National Health and Nutrition Examination Survey (NHANES) 2011-2018 were used, applying multivariable logistic regression analysis to investigate the association between VAT mass and hypertension risk. Independent genetic variants related to VAT mass were derived from genome-wide association studies (GWAS) in 325 153 UK Biobank participants. The primary analysis employed the random-effects inverse-variance weighted (IVW) method, with MR-Egger, weighted median, simple mode, and weighted mode as sensitivity analyses. A total of 7661 participants were included. After adjusting for confounding factors, increased VAT mass was associated with a higher risk of hypertension (quartile 4vs. quartile 1: OR:1.85, 95% confidence intervals [CI]: 1.31-2.63). Furthermore, VAT mass exhibited greater accuracy than body mass index (BMI) in predicting hypertension (areas under the curve [AUC]: 0.701vs. 0.676, p for comparison < 0.001). The MR analyses demonstrated a causal relationship between increased VAT mass and the risk of hypertension in primary analyses (odds ratio [OR]:1.768, 95% CI: 1.594-1.861). Consistent findings across various MR models substantiate the robustness and strength of this causal relationship. These analyses provide additional support for both the positive association and causal relationship between elevated VAT and the risk of developing hypertension, suggesting that targeted interventions for VAT may be beneficial in preventing hypertension.

Six-fold increased risk of acute pancreatitis in alcohol-related liver disease compared to matched comparators: A population-based cohort study.

Patients with alcohol-related liver disease (ALD) might be at increased risk of acute pancreatitis (AP), but large-scale data are lacking. Population-based cohort study using data from the Swedish National Patient Register on 37,062 patients with ALD from 1969 to 2020. Patients were matched to ≤10 general population comparators (n=352,931). We used logistic regression to estimate the risk of acute or chronic pancreatitis prior to ALD diagnosis and Cox regression to estimate rates for hospitalization for AP after ALD diagnosis. Median age at ALD diagnosis was 59 years; 72% were men, and 67% had cirrhosis at baseline. Overall, 7% had experienced pancreatitis before ALD diagnosis, resulting in 9-fold higher odds of pancreatitis compared to comparators. The 10-year cumulative incidence of hospitalization for AP was 2.7% (95%CI=2.5-2.8) in ALD and 0.6% (95%CI=0.58-0.63) in comparators, yielding an adjusted HR of 6.3 (95%CI=5.8-6.9). Younger age, male sex, and diagnoses of alcohol use disorders and chronic obstructive pulmonary disease were independent risk factors for developing AP in ALD. Continued drinking after baseline was associated with a higher risk of AP (adjusted hazard ratio [aHR] 2.6, 95%CI=2.29-2.85). ALD is associated with 9-fold higher odds of prevalent pancreatitis compared to the general population. The hospitalization rate for AP following ALD diagnosis is 6-fold higher. About 10% of patients with ALD have or develop AP, suggesting that assessing history of pancreatitis and its sequelae might be relevant for patients with ALD.

Sex-based differences in risk of revision for infection after hip, knee, shoulder, and ankle arthroplasty in osteoarthritis patients: a multinational registry study of 4,800,000 implants.

We aimed to determine sex differences for periprosthetic joint infections after primary arthroplasty of the hip, knee, ankle, and shoulder in osteoarthritis patients in an international perspective. This is a multinational combined arthroplasty registry study. Each arthroplasty registry performed Cox-regression analysis of their data and reported the crude and adjusted hazard ratios (HR) with an a priori designed data form. A random-effects model was used to pool these HRs to estimate an overall HR with 95% confidence interval (CI). Adjustment was undertaken for patient age, BMI, ASA grade, type of fixation, and type of implant. 9 arthroplasty registries participated. Patients who received primary total joint arthroplasty for primary osteoarthritis were considered: 2,134,313 hip arthroplasties, 2,658,237 knee arthroplasties, 57,889 shoulder arthroplasties, and 8,445 ankle arthroplasties. We calculated hazard ratios (HR) for the overall risk of complete revision due to infection for each implant type and follow-up. The pooled HR for revision due to infection for men compared with women at 1-year follow-up was 1.60 (95% confidence interval [CI] 1.42-1.80) for hip arthroplasties; 2.06 (CI 1.90-2.46) for knee arthroplasties; 4.51 (CI 2.99-6.80) for shoulder arthroplasties; and 0.87 (CI 0.46-1.62) for ankle arthroplasties. These results remained consistent over time and were identified in both unadjusted and adjusted models. Men have a higher risk of revision due to infection than women after primary hip, knee, and shoulder arthroplasty. No evidence of difference was found for ankle arthroplasty. These elevated relative risks persist in the fully adjusted investigations and over the 10-year postoperative period studied.

Impact of concomitant aortic valve replacement in patients with mild-to-moderate aortic valve regurgitation undergoing left ventricular assist device implantation: EUROMACS analysis.

Left ventricular assist device (LVAD) therapy may lead to an aortic regurgitation, limiting left ventricular unloading and causing adverse events. Whether concomitant aortic valve replacement may improve outcomes in patients with preoperative mild-to-moderate aortic regurgitation remains unclear. A retrospective propensity score-matched analysis of adult patients with preoperative mild-to-moderate aortic regurgitation undergoing durable LVAD implantation between 01/01/2011 and 30/11/2021 was performed. Patients undergoing concomitant valve surgery other than biological aortic valve replacement were excluded, resulting in 77 with concomitant biological aortic valve replacement and 385 without. Following 1:1 propensity score matching, two groups of 55 patients with and without biological aortic valve replacement were obtained, (mean age 59 ± 11 years, 92% male, 59.1% HeartWare). Aortic regurgitation was mild in 72.7% and 76.4% and moderate in 27.3% and 23.6% in non-replacement and replacement cohorts respectively. The 30-day survival was 89.1% vs. 85.5% (p = 0.59), 1-year survival 69.1% vs. 56.4% (p = 0.19), and 2-year survival 61.8% vs. 47.3% (p = 0.10) in the non-replacement and replacement groups, respectively. After a mean follow-up of 1.2 years, non-replacement patients had a higher incidence of pump thrombosis (11 [20%] vs. 3 [5.5%], p = 0.022) and fewer major bleedings (2 [3.6%] vs. 11 [20%], p = 0.008). Compared with those treated conservatively, patients with mild-to-moderate aortic regurgitation undergoing concomitant aortic valve replacement during LVAD implantation have a similar survival up to 2 years on support. Patients with concomitant valve replacement had a higher risk of bleeding complications but fewer pump thromboses.

Angiotensin-Converting Enzyme Inhibitor (ACEI) and Angiotensin Receptor Blocker (ARB) Use are Associated With Increased Readmission After Ileostomy Creation.

High output is a common cause for readmission after new ileostomy creation. The loss of sodium leads to compensatory activation of the renin-angiotensin-aldosterone system (RAAS). Angiotensin-converting enzyme inhibitors (ACEI) and angiotensin receptor blockers (ARB) are first-line therapy for hypertension in the United States. We hypothesized that concurrent use of ACEI/ARB increases the risk of readmission following new ileostomy creation due to the loss of this compensatory mechanism. Patients undergoing ileostomy creation between 2009-2022 at an integrated managed health care system were included in this retrospective study. Primary outcomes were hospital readmission and ED visit within 30-days. Additional variables included ACEI/ARB use, ileostomy type, Charlson Comorbidity Index, additional antihypertensives at discharge (furosemide, hydrochlorothiazide, spironolactone, amlodipine, nifedipine, and diltiazem), and readmission diagnosis. Descriptive and advanced statistical analysis was completed with SPSS. Of 540 patients, 41.9% were readmitted or visited an ED within 30 days. There was no difference in readmission or ED visit based on age, gender, or ileostomy type. Patients discharged with ACEI/ARB (37.4% vs 25.5%, P = .005) and additional antihypertensives (37.2% vs 17.3%, P = .006) were at a higher risk for readmission. Inhibition of RAAS is associated with increased risk for hospital readmission. In patients with hypertension undergoing ileostomy creation, individualized care plans are needed with earlier antimotility agent use or intravenous rehydration plans.

Association of Sleep Disturbances With Prevalent and Incident Motoric Cognitive Risk Syndrome in Community-Residing Older Adults.

There is growing evidence that sleep disturbances are associated with cognitive impairment risk, but their association with the incidence of motoric cognitive risk syndrome (MCR)-a predementia syndrome characterized by slow gait speed and cognitive complaints-is unknown. We aimed to examine the association of sleep disturbances, overall and specific subtypes, with (1) incident and (2) prevalent MCR in older adults. Community-residing adults aged 65 years and older without dementia were recruited from population lists and included in Central Control of Mobility and Aging, a prospective cohort study, in Albert Einstein College of Medicine, Bronx, NY. We included participants with available data for MCR and Pittsburgh Sleep Quality Index (PSQI). MCR was defined as cognitive complaints reported on standardized questionnaires and slow gait speed as recorded on an electronic treadmill and was adjudicated at baseline and annual follow-up visits. Participants were divided into "good" sleepers (≤5) and "poor" sleepers (>5) based on an established PSQI cut score. Among participants without MCR at baseline, Cox proportional hazard models adjusted for (1) age, sex, and education and (2) further for comorbidity index, Geriatric Depression Scale score, and global cognitive score were used to examine the association of baseline sleep disturbances with MCR incidence. Association between poor sleep quality and prevalent MCR at baseline in the overall population was explored using multivariate logistic regression analysis. 445 participants were included (56.9% women, mean age: 75.9 years [75.3; 76.5]). In MCR-free participants at baseline (n = 403), 36 developed incident MCR over a mean follow-up of 2.9 years. Poor sleepers had a higher risk of incident MCR (HR = 2.7 [1.2; 5.2]) compared with good sleepers, but this association was not significant after adjustment for depressive symptoms (adjusted hazard ratio [aHR] = 1.6 [0.7-3.4]). Among the 7 PSQI components, only sleep-related daytime dysfunction (excessive sleepiness and lower enthusiasm) showed a significant risk of MCR in fully adjusted models (aHR = 3.3 [1.5-7.4]). Prevalent MCR was not associated with poor sleep quality (OR [95% CI] = 1.1 [0.5-2.3]). Overall poor sleep quality was associated with incident MCR, but not with prevalent MCR. Specifically, older adults with sleep-related daytime dysfunction are at increased risk of developing MCR. Further studies are needed to validate mechanisms of this relationship.

Prevalence of high-risk group for obstructive sleep apnea using the STOP-Bang questionnaire and its association with cardiovascular morbidity

ObjectivesObstructive sleep apnea (OSA) is a common sleep-related breathing disorder, yet many cases remain undiagnosed. The STOP-Bang questionnaire was developed to identify individuals at high risk of OSA. We aimed to investigate the prevalence of individuals with suspected OSA using the STOP-Bang risk stratification in the general population of South Korea. Additionally, we determined if the STOP-Bang risk stratification independently predicts cardiovascular morbidity.MethodsData from the eighth Korea National Health and Nutrition Examination Survey (2019–2020) were used. Participants aged ≥40 with complete data for STOP-Bang questionnaire were included. A STOP-Bang score of ≥5 classified individuals as high-risk whereas scores of 3–4 and less than 3 classified them as intermediate- and low-risk, respectively. The association between the high-risk group and cardiovascular morbidity was analyzed using complex sample logistic regression.ResultsAmong the 6,630 participants included, approximately 6.7% were classified as high-risk based on the STOP-Bang questionnaire. The prevalence of diagnosed OSA in the high-risk group was 4.0%. The high-risk group showed a significantly higher prevalence of cardiovascular morbidity (11.9%) compared to those in the low- and intermediate-risk groups (3.0 and 8.1%, respectively). After adjusting for variables associated with cardiovascular risk, the high-risk group remained an independent predictor of increased likelihood of cardiovascular morbidity compared to the low-risk group (odds ratio, 2.05; p = 0.002). When stratified by sex, STOP-Bang high-risk was significantly associated with cardiovascular morbidity in men; however, the same trend was not observed in women.ConclusionWe found a significant proportion of individuals at high risk of OSA is likely to remain undiagnosed in the general population of South Korea. The high-risk group demonstrated a higher burden of cardiovascular morbidity, and the STOP-Bang high-risk group was an independent predictor of cardiovascular morbidity.

Stress-Related Disorders Among Young Individuals With Surgical Removal of Tonsils or Adenoids.

Studies have suggested an increased risk of psychiatric disorders and suicidal behavior among individuals who have undergone tonsillectomy. However, little is known about stress-related disorders. To investigate whether surgical removal of tonsils or adenoids is associated with a subsequent risk of stress-related disorders. This cohort study used Swedish nationwide population and health registry data of all individuals born between January 1, 1981, and December 31, 2016. Individuals who had undergone surgical removal of tonsils or adenoids (ie, exposed persons) were compared with unrelated unexposed individuals individually matched by sex, birth year, and calendar date at the start of follow-up (population-matched cohort) and with their unexposed full siblings (sibling-matched cohort). The analysis was performed between December 15, 2023, and October 11, 2024. Surgical removal of tonsils or adenoids. The Swedish Patient Register was used to identify stress-related disorders, including posttraumatic stress disorder (PTSD), acute stress reaction, and adjustment disorder or other stress reaction. In the population-matched cohort, a Cox proportional hazards regression model was used to assess the association of tonsillectomy with the risk of stress-related disorders, conditioned on sex, birth year, and calendar date at the start of follow-up and adjusted for parental educational attainment and history of stress-related disorders. To address potential familial confounding, analyses were replicated using the sibling-matched cohort. The population-matched cohort included 83 957 exposed and 839 570 unexposed persons (median [IQR] age at the start of follow-up, 14.4 [6.5-18.6] years; 55.2% female), and the sibling-matched cohort included 51 601 exposed persons (median [IQR] age at start of follow-up, 14.9 [6.9-18.7] years, 55.8% female) and 75 159 unexposed full siblings (median [IQR] age at start of follow-up, 13.3 [6.9-19.5] years; 52.6% male). Compared with the unexposed population reference, exposed persons exhibited a higher subsequent risk of stress-related disorders (hazard ratio [HR], 1.43; 95% CI, 1.38-1.48), especially PTSD (HR, 1.55; 95% CI, 1.43-1.69). These results were replicated in the sibling-matched cohort (any stress-related disorder: HR, 1.34 [95% CI, 1.25-1.44]; PTSD: HR, 1.41 [95% CI, 1.18-1.69]). An increased risk was consistently noted regardless of sex, age at surgery, time since surgery, parental educational attainment, or parental history of stress-related disorders and was mainly noted for a surgery due to adenotonsillar diseases or sleep and respiratory abnormalities. In this cohort study, the findings suggest that early-life surgical removal of tonsils or adenoids is associated with a higher future risk of stress-related disorders and highlight a need to understand the role of adenotonsillar diseases or associated health conditions in the development of stress-related psychiatric disorders.

Performance of the Implant Disease Risk Assessment in Predicting Peri-Implantitis: A Retrospective Study.

This university-based retrospective study aimed to assess the performance of the implant disease risk assessment (IDRA) in predicting peri-implantitis. Patients with implants loaded for at least 1 year were included. Peri-implantitis development was the outcome, while the IDRA score and its eight vectors were the predictors. The IDRA score was calculated using an online tool. Data were analyzed using Cox proportional hazards models and ROC curve (AUC). Among 480 implants in 235 patients, 7.9% of implants and 9.4% of patients developed peri-implantitis. Implants at high risk for the "number of sites with PD ≥ 5 mm" vector had an increased risk (HR = 9.8, p = 0.004) of peri-implantitis, compared to those at low risk for this parameter. Implants at moderate (HR = 4.8, p = 0.04) and high (HR = 10.0, p = 0.01) risk for the "distance from the restorative margin (RM) to bone crest (BC)" vector exhibited a higher risk of peri-implantitis than implants at low risk for this parameter. The IDRA tool demonstrated an AUC of 0.66 (sensitivity = 0.80; specificity = 0.24) when estimated at implant level and an AUC of 0.61 (sensitivity = 0.91; specificity = 0.32) when calculated at patient level. The mixed-effects Cox model did not reveal a significant association between the overall IDRA score and the development of peri-implantitis (HR = 7.2, p = 0.18). IDRA demonstrates good sensitivity but low specificity and suboptimal discriminatory capacity in predicting peri-implantitis. The "number of sites with PD ≥ 5 mm" and "distance from RM to BC" emerged as the most effective predictors for peri-implantitis.

High Risk of HPV Related Preneoplastic and Neoplastic Vulvar Lesions in Women Living With HIV.

We aimed to investigate the epidemiology of human papilloma virus (HPV)-related preneoplastic and neoplastic vulvar lesions in a large cohort of women living with HIV (WLWH). We retrospectively selected 1,796 WLWH who had a gynecological examination, cervical cytology, high-risk (HR-) HPV test, vulvoscopy, and colposcopy with targeted biopsies when necessary between 1987 and 2020 at 2 Italian institutions. Univariable and multivariable regression analyses were carried out to test the association of the anamnestic and clinical data with the development of precancerous and cancerous lesions. At baseline, 348 (19.4%) of 1,796 WLWH had genital warts, 30 (1.7%) had vulvar high-grade intraepithelial neoplasia (VHSIL), and 2 (0.1%) had squamous cell carcinoma of the vulva. Among 895 WLWH who had more than 1 year of follow-up, we found 40 (4.5%) new cases of VHSIL and 7 (0.8%) cases of vulvar cancer. The cumulative incidence of VHSIL and vulvar cancer was respectively 0.56 and 0.10 per 100 person-years. Risk factors independently associated with the development of vulvar HSIL and cancer included history of injection drug use (p < .01), genital warts at baseline (p < .001), HR-HPV test positivity at diagnosis (p < .001), and severe immunodepression (CD4 cell count <200 cells/mL) at diagnosis (p < .01). WLWH are at high risk of vulvar high-grade intraepithelial neoplasia and cancer, especially those with severe immunodepression. A careful inspection of vulva, perineum and anus, possibly with the aid of colposcopy, should become part of the surveillance protocol of HIV-infected women.

Meta-analysis: the prophylactic use of tranexamic acid to reduce blood loss during caesarean delivery.

The 2022 national guideline on The Prevention and Management of Primary Postpartum Haemorrhage (PPH) recommended consideration of prophylactic tranexamic acid (TXA) for women who are at high PPH risk undergoing caesarean section (CS). This meta-analysis reviews the basis for this recommendation. PubMed, OVID Medline, EMBASE, Science Citation Index, Scopus, CENTRAL, and ClinicalTrials.gov were searched (from inception to January 2024) for randomised controlled trials comparing prophylactic intravenous TXA with placebo or no treatment in women undergoing CS who received a uterotonic. Our main outcome was PPH > 1L. Secondary outcomes included estimated mean blood loss, blood transfusion, drop in haemoglobin, the need for additional uterotonics, or surgical intervention. Adverse effects of TXA were also assessed. Sixty-one studies including 25,098 women were identified, and 12,446 received prophylactic TXA. Patients who received prophylactic TXA had significantly reduced likelihood of PPH > 1L (RR, 0.47; 95% CI, 0.38 to 0.59), reduced estimated mean blood loss (MD 185.86 ml, 95% CI 159.14-212.59), and reduced drop in Hb (MD 0.84g/dl, 95% CI 0.72, 0.95). There was a significant reduction in need for additional uterotonics (RR 0.47, 95% CI 0.39-0.57) or surgical intervention (RR 0.54, 95% CI 0.30-0.95). The reduced risk of PPH > 1L was greatest in patients at higher risk of bleeding. The greatest risk reduction was seen in smaller studies and in studies undertaken in developing economies. Prophylactic TXA administration is effective at reducing the incidence of PPH > 1L at CS. The clinical benefit of universal prophylaxis is questionable; women who are high risk of PPH are more likely to derive benefit.

Evaluation of Lipid Profile and Statin Therapy in Patients with Atrial Fibrillation: Real-Life Data from a Tertiary Hospital

Objectives: Dyslipidemia is a modifiable risk factor of atrial fibrillation (AF). However, the majority of patients either do not receive low-density lipoprotein cholesterol (LDL-C) lowering treatment or do not meet their LDL-C and non-high-density lipoprotein cholesterol (non-HDL-C) goal. We aimed to search whether patients with AF are being treated for dyslipidemia and/or are at target LDL-C and non-HDL-C levels if treated. Methods: This cross-sectional analysis includes 725 AF patients and was performed between 20 May 2023 and 25 November 2023, in cardiology outpatient clinics of a tertiary hospital. The demographic and clinical features of the patients were recorded. Systemic coronary risk estimation-2 (SCORE2) and old person version algorithms were used for cardiovascular disease (CVD) risk estimation. Primary prevention (PP) group involved patients with low-to-moderate, high and very high CVD risk without established atherosclerotic cardiovascular disease (ASCVD) and secondary prevention (SP) group was consisted of patients with established ASCVD. Results: The mean age of the participants was 71.98± 9.01 and 54.5% (n=368) of patients were females. 207 (30.7%) of patients were paroxysmal AF, and 468 (69.3%) were permanent AF. Prevalence of dyslipidemia and hypertriglyceridemia were 364 (53.9%) and 248 (36.7%) respectively. 9 (1.3%) and 152 (22.5%) of patients were on fibrate and statin treatment respectively. Mean LDL-C and non-HDL-C were 107.81±35.97 and 135.42±41.19 and their target attainment rates were 62 (9.2%) and 107 (15.9%), respectively. Conclusion: Control of dyslipidemia in patients with atrial fibrillation was severely poor and the most common cause was physician negligence.

Health and Lifestyle Factors and Dementia Risk Among Former Professional Soccer Players.

Elite-level contact sport participation is associated with increased dementia risk, which may be attributable to sport-related traumatic brain injury and repetitive head impact exposure. However, the contribution of wider, potentially modifiable dementia risk factors remains uncertain. To explore the association of potentially modifiable dementia risk factors with dementia risk among former professional soccer players. This retrospective cohort study used electronic health record linkage to national electronic datasets of general and mental health hospital inpatient and day-case admissions, prescribing information, and death certification in Scotland for male former professional soccer players born between January 1, 1900, and December 31, 1990, who were aged 30 years or older on December 31, 2020, and general population control individuals matched by sex, year of birth, and area socioeconomic status. Database interrogation was performed on November 30, 2021, and data were analyzed between January 16, 2023, and July 8, 2024. History of smoking, depression, alcohol-related disorders, diabetes, hypertension, hearing loss, and obesity coded within electronic health records. Prevalence of dementia risk factors and their association with incident dementia diagnoses were evaluated and compared between former soccer players and matched controls. The final cohort consisted of 11 984 male former professional soccer players and 35 952 matched controls. Over a median 21 years (IQR, 7-34 years) of follow-up from study entry at age 30 years or older, providing a total of 1 039 848 years of follow-up, 434 former soccer players (3.62%) and 453 matched population controls (1.26%) were identified with a dementia diagnosis (hazard ratio [HR], 3.02; 95% CI, 2.54-3.58; P < .001). Overall, rates of general health and lifestyle dementia risk factors were similar or lower among former soccer players compared with matched controls (eg, diabetes: 4.26% vs 6.35%). Dementia risk associated with these factors among soccer players was similar to or lower than among controls (eg, hypertension: HR, 4.62 [95% CI, 3.69-5.78] vs 6.96 [95% CI, 5.64-8.59]). This cohort study found no evidence that high dementia risk among former professional soccer players was associated with potentially modifiable general health and lifestyle dementia risk factors. These data support continuation of measures directed toward reducing exposure to repetitive head impacts and traumatic brain injury in sport.