Higher BMI Research Articles

Comparison of responders and nonresponders with knee osteoarthritis after transcranial direct current stimulation.

The study compared responders and nonresponders to transcranial direct current stimulation (tDCS) regarding clinical pain outcomes in knee osteoarthritis (OA) patients. Sixty participants received home-based active tDCS, and clinical pain outcomes were compared between responders and nonresponders. Latent class growth analyses classified 41 participants as responders and 19 as nonresponders. Responders showed significantly greater decreases in pain intensity from baseline to post intervention than nonresponders (p < .001). Participants with higher BMI (p = .02) and weight (p = .005) were more likely to respond, while no significant sociodemographic differences were found. Identifying characteristics of nonresponsive tDCS subgroups can tailor treatments for each group. www.clinicaltrials.gov identifier is NCT04016272.

STUDIES OF ASTHMA CONTROL IN PATIENTS WITH METABOLIC SYNDROME

Every day, a practitioner is faced with the problem of patient comorbidity. Bronchial asthma is a common problem, as is metabolic syndrome. Due to the increase in allergic diseases and lifestyle changes, patients may have a combination of metabolic syndrome and bronchial asthma. This combination has been shown to aggravate the course of asthma. Therefore, we wanted to confirm or refute this with our study. The study design included 94 patients with a diagnosis of asthma. A comparative analysis of the spirographic study data revealed that patients with asthma + MetS had statistically significant differences (p&lt;0.05). The analysis of anthropometric data revealed that patients with the highest BMI and body weight had a significantly more severe course of asthma (p&lt;0,05), which is consistent with the data of available world studies [24, 25], and a positive correlation was found between BMI, percentage of body fat and lower percentage of body fat in patients with severe asthma (ρ=0,89, ρ=0,90, ρ=0,87; r=0,88, r=0,91, r=0,90, respectively). The data obtained indicate the need for individual management of patients with comorbidities, including MetS and asthma, to prevent severe asthma, which is associated with inadequate asthma control and poor quality of life.

BS O01 - Comparison of Roux-en-Y Gastric Bypass(RYGBP) and Laparoscopic Sleeve Gastrectomy(LSG) in patients with obesity and diabetes mellitus: Meta-analysis and systemic review

Abstract Background Laparoscopic Sleeve gastrectomy (SG) and Roux-en-Y Gastric Bypass (RYGB) are the two procedures used to treat patients with obesity and type 2 diabetes mellitus(T2DM). However, it is still unclear which of the two procedures is better for T2DM remission. This study aims to compare the effectiveness of LSG and RYGB considering important comparison outcomes including diabetes remission, and overall glycemic and metabolic control. Method We conducted a comprehensive search of Medline, PubMed, the Cochrane Library, Scopus, the Web of Science, Clinical Key, Ovid, and Wiley from their inceptions through August 2022 for randomized controlled trials (RCTs) comparing LSG with RYGB for patients with morbid obesity and T2DM. The data were extracted and pooled using Review Manager software (RevMan5.4). Results Eighteen RCTs including 1360 patients were found. After one year, two years, and five years, the RYGB group's BMI was significantly lower than the LSG group's as follows respectively (MD = -1.58, P &amp;lt; 0.0001), (MD = -1.64, P=0.03), and (MD = -2.26, P= 0.0004). Moreover, the LSG group had a higher incidence of diabetes remission than the RYGP group after five years. Although there was no significant difference in terms of safety outcomes between both groups, GERD was significantly higher in the LSG group, and dumping syndrome was significantly higher in the RYGB group. Conclusion RYGB is more effective in achieving weight loss and reducing BMI, while LSG shows better improvement in diabetes remission, notably for those with high BMI. Both surgeries have similar complication rates, but RYGB has a higher incidence of dumping syndrome and lower rates of GERD compared to LSG.

EGS SO04 - Gastrodoudenal Artery Pseudoaneurysm Secondary to blunt abdominal trauma: A rare case report

Abstract Background Visceral artery pseudoaneurysms (VAPAs) are rare, potentially life-threatning aneurysms found in the celiac, superior, or inferior mesenteric arteries. They are most common in the splenic artery (60-70%), followed by hepatic arteries (20%) and celiac or mesenteric arteries (10%). Usually asymptomatic, VAPAs are often discovered incidentally during abdominal imaging. They pose a high risk of rupture and haemorrhage. Risk factors include iatrogenic injury and abdominal trauma. Traumatic VAPAs are extremely rare with unclear management guidelines. Treatment options vary from observation to endovascular therapy or surgical repair. This report presents a case of a gastoduodenal artery psuedoaneurysm due to blunt abdominal trauma. Method A case report: a 68-year-old male with a high BMI and atrial fibrillation managed with edoxaban, presented with severe upper abdominal pain following a fall. Initial examination and laboratory results suggested acute pancreatitis or cholecystitis, but a CT angiography revealed a GDA pseudoaneurysm with active extravasation. The patient was referred for urgent therapeutic embolization; however, the pseudoaneurysm had spontaneously thrombosed, precluding the need for embolization. The patient was managed conservatively, with close monitoring in the high dependency unit (HDU), analgesics, proton pump inhibitors, and mechanical venous thromboembolism prophylaxis. He remained hemodynamically stable and was discharged with instructions for follow-up care. Results GDA pseudoaneurysms are rare, accounting for 0.01-1% of all visceral artery aneurysms, with trauma being an exceptionally infrequent cause. The management of VAPAs, particularly in hemodynamically stable patients, can range from conservative observation to endovascular interventions. This case underscores the importance of a multidisciplinary approach involving surgery, interventional radiology, and vascular teams for optimal management. Conclusion Gastroduodenal artery pseudoaneurysms secondary to blunt abdominal trauma can be effectively managed conservatively in stable patients. Comprehensive history-taking, appropriate imaging, and multidisciplinary discussions are crucial for successful outcomes. Continued monitoring is essential to ensure patient safety and address potential complications.

BN SO05 - Risk Factors associated with Complications Post-Laparoscopic Common Bile Duct Exploration: A Comprehensive Literature Review

Abstract Background Gallstone-related diseases, particularly common bile duct (CBD) stones, present a significant global health issue. The adoption of laparoscopic common bile duct exploration (LCBDE) has revolutionized the management of these conditions by providing a minimally invasive alternative to open surgery. This literature review aims to identify and analyze the risk factors associated with complications in LCBDE, thereby offering insights to improve patient care and outcomes. Method comprehensive search for primary research studies, systematic reviews, and meta-analyses pertaining to risk factors for complications following LCBDE. The search was conducted on PubMed, focusing on English-language articles published within the last 20 years and encompassing all age groups. Peer-reviewed journal articles were prioritized. All relevant studies reporting complications after LCBDE were eligible for inclusion if available as full texts, structured abstracts, or conference reports. The initial search yielded 826 articles. Exclusion criteria : open surgery, non-English articles, lacking full-text. A total of 29 records were identified by the literature search. Results Laparoscopic common bile duct exploration (LCBDE) is generally safe and effective, with complication rates influenced by patient and procedural factors. Older age, comorbidities, previous abdominal surgeries, high BMI, narrow common bile ducts, and difficult stones increase risks. Experienced surgeons and shorter operative times reduce complications. The transcystic approach and primary suture closure have fewer complications compared to the transductal route and T-tube drainage, respectively. Intraoperative imaging significantly reduces risks by ensuring complete stone clearance and identifying anatomical variations. Tailoring surgical approaches to patient-specific factors and leveraging surgical expertise are crucial for minimizing complications in LCBDE. Conclusion LCBDE emerges as a safe and effective therapeutic modality for addressing conditions impacting the bile ducts (31). The success and utility of LCBDE can be significantly enhanced through the meticulous optimization of patient-related, surgeon-related, and procedure-related factors. By addressing and fine-tuning these key elements, the occurrence of complications associated with LCBDE can be mitigated, thereby reinforcing its potential as a primary choice for managing various bile duct conditions. This strategic approach not only underscores the clinical efficacy of LCBDE but also advocates for its expanded utilization as a frontline intervention in the comprehensive management of bile duct disorders.

BN SO50 - The Resurgence of Veress Needle Insufflation: An Evaluation of Efficacy and Safety of One Surgeon’s Practice

Abstract Background Veress needle insufflation has been established as a safe and effective method of establishing pneumoperitoneum for laparoscopic surgery, with comparable risk profile to open methods. However, the blind nature of the procedure with potential complications such as iatrogenic bowel and blood vessel injury has seen this technique fall out of fashion with general surgeons. This study reviews the safety and efficacy of a single surgeon’s practice using Veress needle insufflation for Laparoscopic surgical procedures. Method A retrospective analysis was conducted on minimally invasive procedures performed between January 2019 and June 2024. In our practice, a standard or bariatric Veress needle is placed in a small incision at Palmer’s point. A manometer test is performed with CO2 insufflation at a low flow rate and raising the abdominal wall. If a low pressure is established, then the flow is increased to achieve adequate pneumoperitoneum before introduction of a midline 5mm camera port. Primary outcomes of this study include rate of conversion to open techniques (either Hasson’s or open cut down) and any complications. Results Of the 702 cases reviewed, five patients (0.71%) required conversion to open insufflation techniques. Two (0.28%) had bleeding from the omentum, and one patient (0.14%) experienced inadvertent bowel insufflation which was managed conservatively with no long-term morbidity. Notably there were no port site hernias. Conclusion This study supports the continued use of the Veress needle as a safe and effective method of insufflation in laparoscopic surgery. It offers minimal incision size, easier access in high BMI patients, and an alternative when adhesions and scarring limit access. Furthermore, adopting this technique can be particularly useful for appropriate port placement in robotic surgery, making it a valuable tool for modern surgical practices.

Abstract 4126672: Clinical Predictors and Outcomes of Catheter-Directed Therapies in Patients with Intermediate-Risk Central Pulmonary Embolism

Background: The management of intermediate-risk pulmonary embolism (PE) is unclear. The use of catheter-directed therapies (CDTs) in these patients has increased. However, their selection is not standardized, and outcomes of CDT compared to anticoagulation alone (ACA) are limited. Research Question: What are the clinical predictors of using CDT and their outcomes compared to ACA? Methods: Single center, 11-year, retrospective study of patients with intermediate-risk central PE. We stratified data by CDT use vs. ACA. We used the simplified pulmonary embolism severity index (sPESI) and right ventricular (RV) dysfunction as surrogates of PE severity and the VTE-BLEED score for baseline bleeding risk. We looked for predictors of CDT use and bleeding complications on multivariate logistic regression analyses. Results: Of 490 patients identified, 110 (22%) underwent CDT (Figure 1, Table 1). Higher BMI (OR 1.04, 95% CI 1.01-1.06; p=0.002), prior venous thromboembolism (VTE) episodes (OR=1.92, 95% CI 1.05-3.50; p=0.032), saddle PE (OR=3.42, 95% CI 2.00-5.85; p&lt;0.0001), RV dysfunction (OR=6.93, 95% CI 3.53-13.57; p&lt;0.0001), and creatinine elevation (OR=1.36, 95% CI 1.13-1.64; p=0.001) were independently associated with CTD use (Table 2). After adjusting for PE severity and bleeding risk, CDT was independently associated with bleeding complications (OR=3.77, 95% CI 1.74-8.15; p=0.001) (Table 3). The overall in-hospital mortality was low (3%, n=13). Conclusions: Higher BMI, prior VTE, saddle PE, RV dysfunction, and creatinine elevation were independently associated with CDT use. The CDT group had more major bleeding without mortality difference compared to ACA. Further studies are needed to standardize the use of CDT in intermediate-risk PE.

Abstract 4138350: Candidemia in Patients with Left Ventricular Assist Device-A Case Series

Introduction: Candidemia is rare but associated, have significant morbidity and mortality. Outcomes are not well-characterized in patients with left ventricular assist devices (LVADs). With an increasing number of patients living with LVADs, we sought to characterize risk factors to help optimize outcomes for this high-risk population. Methods: We retrospectively reviewed records of 97 patients who underwent LVAD implant between January 2012 to May 2024 at Indiana University Health, Indianapolis Indiana. Demographic and clinical data were extracted. Candidemia was defined as a positive blood culture with candida species. Result: We identified three patients with candidemia, with an overall attack rate of 3.09%. All patients had a HeartMate III (HM3) at the time of infection. The mean age of patients was 40.3 years (Range 29.0 – 58.0 years) and mean BMI was 35.7 kg/m 2 (Range, 30.0 – 42.0 kg/m 2 ). One patient grew Candida auris and Candida tropicana, the other patient grew Candida auris and the third patient grew Candida globrata. All patients had an automatic implantable cardiac defibrillation, a peripherally inserted central catheter line, and right heart failure. Two patients had driveline infections (one fungal, one bacterial) while one patient developed LVAD endocarditis with a right ventricular outflow tract vegetation. Two patients had persistently positive blood cultures despite treatment with a multi-drug anti-fungal regimen (Flucytosine, Amphotericin B and micafungin) and expired. The third patient initially cleared her blood cultures after treatment with IV micafungin only but was re-admitted with muti-organ failure and expired. Summarily, all patients with candidemia died with a mortality rate of 100%. None of the patients were candidates for heart transplantation. Average survival from the time of diagnosis of candidemia was 5 months (Range 1.0 – 11.0 months). RHF, chronic DL infection and high BMI were associated with candidemia in our series. Conclusion: Candidemia in LVAD patients, while less common than bacterial infections, carry high mortality without cardiac transplantation (100% mortality in our cohort). Its rare occurrence makes it challenging to identify reversible risk factors, leading to poor survival. Multicenter registries are needed to fully elucidate these risk factors and determine effective treatment strategies.

Association of plasma homocysteine with cardiometabolic multimorbidity: a cross-sectional study in northwest China.

Elevated homocysteine (Hcy) levels have been linked to cardiovascular disease (CVD), but their association with cardiometabolic multimorbidity (CMM) remains uncertain. Data from the baseline survey of the China Northwest Cohort-Ningxia Project (CNC-NX) were used to recruit 22,566 participants. Demographic characteristics, lifestyle factors, and laboratory exam results were collected. Logistic regression was used to evaluate the association between Hcy levels and CMM risk. Restricted cubic splines (RCS) explored potential non-linear relationships, and subgroup analyses assessed the consistency of the association across distinct groups. Sensitivity analysis accounted for cluster variability. The final analysis included 18,126 participants. Higher Hcy levels were significantly associated with an increased risk of CMM (adjusted OR = 1.005, P = 0.003), with a linear relationship confirmed by RCS analysis (P for non-linearity = 0.142). There was a stronger association between Hcy-CMM in high-risk people, including elderly, males, and those with high BMI (P < 0.05). No significant association was observed between Hcy levels and more severe types of CMM. Elevated Hcy levels are correlated with an increased risk of CMM, warranting further investigation into the underlying mechanisms and potential interventions. Given the individual differences in the Hcy-CMM relationship, targeted comprehensive interventions for high-risk groups are necessary to reduce the risk of CMM.

The metabolic and circadian signatures of gestational diabetes in the postpartum period characterised using multiple wearable devices.

Gestational diabetes mellitus (GDM) affects 14% of all pregnancies worldwide and is associated with cardiometabolic risk. We aimed to exploit high-resolution wearable device time-series data to create a fine-grained physiological characterisation of the postpartum GDM state in free-living conditions, including clinical variables, daily glucose dynamics, food and drink consumption, physical activity, sleep patterns and heart rate. In a prospective observational study, we employed continuous glucose monitors (CGMs), a smartphone food diary, triaxial accelerometers and heart rate and heart rate variability monitors over a 2 week period to compare women who had GDM in the previous pregnancy (GDM group) and women who had a pregnancy with normal glucose metabolism (non-GDM group) at 1-2 months after delivery (baseline) and 6 months later (follow-up). We integrated CGM data with ingestion events recorded with the smartphone app MyFoodRepo to quantify the rapidity of returning to preprandial glucose levels after meal consumption. We inferred the properties of the underlying 24 h rhythm in the baseline glucose. Aggregating the baseline and follow-up data in a linear mixed model, we quantified the relationships between glycaemic variables and wearable device-derived markers of circadian timing. Compared with the non-GDM group (n=15), the GDM group (n=22, including five with prediabetes defined based on fasting plasma glucose [5.6-6.9 mmol/l (100-125 mg/dl)] and/or HbA1c [39-47 mmol/mol (5.7-6.4%)]) had a higher BMI, HbA1c and mean amplitude of glycaemic excursion at baseline (all p≤0.05). Integrating CGM data and ingestion events showed that the GDM group had a slower postprandial glucose decrease (p=0.01) despite having a lower proportion of carbohydrate intake, similar mean glucose levels and a reduced amplitude of the underlying glucose 24 h rhythm (p=0.005). Differences in CGM-derived variables persisted when the five women with prediabetes were removed from the comparison. Longitudinal analysis from baseline to follow-up showed a significant increase in fasting plasma glucose across both groups. The CGM-derived metrics showed no differences from baseline to follow-up. Late circadian timing (i.e. sleep midpoint, eating midpoint and peak time of heart rate) was correlated with higher fasting plasma glucose and reduced amplitudes of the underlying glucose 24 h rhythm (all p≤0.05). We reveal GDM-related postpartum differences in glucose variability and 24 h rhythms, even among women clinically considered to be normoglycaemic. Our results provide a rationale for future interventions aimed at improving glucose variability and encouraging earlier daily behavioural patterns to mitigate the long-term cardiometabolic risk of GDM. ClinicalTrials.gov no. NCT04642534.

Abstract 4141440: Pharmacokinetics and pharmacodynamics of SC furosemide in patients with HF and obesity

Background: Obesity is increasingly prevalent in patients with heart failure (HF). Subcutaneous (SC) furosemide (Furoscix) is available as a 5-hour SC infusion via an on-body delivery device for the management of congestion, independent of ejection fraction. In a PK/PD study, the average bioavailability of Furoscix across the BMI spectrum was 99.6% with comparable diuresis and natriuresis to IV furosemide. However, the potential effects of obesity on the absorption and diuretic efficacy of Furoscix remain unknown. Goal: To evaluate PK/PD of SC furosemide compared to IV administration, stratified by BMI. Methods: Post-hoc analysis of SC furosemide pivotal PK/PD study was conducted to compare PK and urine output (UO) to IV furosemide, stratified by BMI. SC furosemide 80mg was administered over 5 hours per the typical biphasic administration schedule. IV furosemide was given as two 40mg injections, 2 hours apart. Plasma was collected to determine furosemide concentrations and UO was quantified over 8 hours. Descriptive statistics were reported. Results: Sixteen patients were included for UO and 15 for the PK analysis. Median BMI was 31.2kg/m 2 ; PK stratified by BMI is listed in Table 1. Peak plasma furosemide concentration (C max ) was lower in the BMI &gt;31.2kg/m 2 group with no difference in t 1/2 and greater UO at 8 hours in this cohort. There was no difference in any of the variables between the SC and IV agents across the BMI spectrum. Conclusion: Although Furosemide C max was lower in the cohort with BMI &gt;31.2kg/m 2 , total UO at 8 hours was higher. These findings were similar for the SC and IV formulations. Our data suggests that SC furosemide absorbs independent of BMI and provokes a reliable clinical response as measured by UO. Importantly, PK and UO results are consistently similar between the Furoscix and IV formulation across the BMI spectrum. Future research is warranted to investigate the reasons behind the increased UO in the population with higher BMI.

Abstract 4123804: Joint associations of sleep and daily step count with cardiometabolic health markers: a pooled analysis of the ProPASS consortium

Background: Poor sleep and physical inactivity are lifestyle-related behaviors that impact cardiometabolic health, but there is limited insight into their combined association with cardiometabolic markers. Aims: This study investigated the joint association of device-measured sleep patterns (regularity and duration) and daily step counts with cardiometabolic biomarkers. Methods: Harmonized individual participant data of 12,223 adults (mean±SD age:54.6±9.5 years; 54.8% female) from the pooled Prospective Physical Activity, Sitting and Sleep consortium (ProPASS), comprising six cohorts with thigh-worn accelerometry data were analysed. Sleep regularity was assessed using the validated Sleep Regularity Index (SRI, range 0-100), quantifying day-to-day sleep consistency. We used generalized linear models to examine cross-sectional joint associations between sleep patterns, regularity (SRI tertiles ≤75.8, low; 75.8-84.5, medium; &gt;84.5, high) and duration (&lt;7h, short; 7-8h, adequate; &gt;8h, long), and daily step counts (step tertiles &lt;8488, low; 8488-11601, medium; &gt;11601, high steps/day) with a composite cardiometabolic health score and individual biomarkers, including BMI, waist circumference, total cholesterol, HDL cholesterol, triglycerides, and HbA1c. Results: Lower sleep regularity, deviation from adequate sleep, along with lower step counts were adversely associated with the composite cardiometabolic health risk score. Compared to optimal sleep patterns (SRI&gt;84.5 or 7-8h/day) and high step groups, low sleep regularity and short sleep duration were separately associated with the least favourable composite cardiometabolic health (z-score [95%CI] 0.32 [0.28,0.37] and 0.25 [0.21,0.29], respectively) among participants with low volume of steps. Low sleep regularity and low daily steps were jointly associated with higher BMI (2.98 [2.67,3.29] kg/m 2 ), waist circumference (8.61 [7.81,9.4] cm), total cholesterol (0.15 [0.08,0.23] mmol/L), and lower HDL levels (0.17 [0.14,0.2] mmol/L), regardless of sleep duration. For short/long sleep duration and low daily step count, such associations were only evident in BMI and waist circumference. Conclusions: Our findings suggest that the potential deleterious associations of irregular or inadequate sleep duration with cardiometabolic health outcomes may be exaggerated by lower daily step counts. Future studies should examine the prospective joint association of sleep patterns and physical activity on cardiometabolic health.

Abstract 4134249: Cardiovascular Risk Factors and Associations of Chronic Inflammatory-Related Disease in the Multi-Ethnic Study of Atherosclerosis

Background: Inflammation plays a role in the development of cardiovascular disease (CVD). We have defined various non-cardiovascular and non-cancer conditions, both infectious and non-infectious, with a common basis of inflammation; collectively termed Chronic Inflammatory-Related Disease (ChrIRD). We have previously described that ChrIRD is common, associated with baseline inflammatory marker levels, associated with high mortality, and has a bidirectional association with CVD. The clinical implications of these data require further study. Aims: We hypothesize that many traditional risk factors for CVD are also associated with ChrIRD and that ChrIRD has additional unique risk factors. We also hypothesize that the treatment of traditional CVD risk factors is associated with a decreased likelihood of ChrIRD. Methods: We studied MESA participants free of overt CVD or significant illness at baseline. ChrIRD was determined based on review of ICD codes for hospitalizations and deaths. Incident CVD was adjudicated by review of medical records. We performed proportional hazards regression (time-dependent for CVD) to identify factors associated with a first diagnosis of ChrIRD. All variables were simultaneously entered into the model. Results: Participants (n=6155) had mean age 62±10 years and 47% male gender. ChrIRD was observed in 24% and CVD in 18%; including 8% with both conditions. Participants with a diagnosis of CVD, older age, higher heart rate, higher BMI, current or ever smoking status, higher HDL, higher baseline IL6 and GlycA levels, and NSAID use had increased likelihood of ChrIRD. Whereas those with female sex, higher total cholesterol, and statin use had a decreased likelihood of ChrIRD. Participant race/ethnicity, blood pressure, diabetes status, antihypertensive use, aspirin use, baseline CRP level, and baseline D-dimer level were not associated with ChrIRD. Regression results are summarized in Table 1. Conclusions: ChrIRD shares some risk factors with CVD, while other risk factors are opposite. Better understanding of ChrIRD could eventually lead to improved patient care.

Abstract 4123478: The Impact of Social Determinants on Growth at 10 Years After the Norwood Procedure: Results from the Single Ventricle Reconstruction (SVR) Trial III

Background: The impact of social determinants of health (SDOH) on growth in patients with hypoplastic left heart syndrome (HLHS) is understudied. In a secondary analysis of the Pediatric Heart Network SVR III study, we explored the impact of SDOH on longitudinal somatic growth through age 10 years in transplant-free survivors with HLHS. Methods: Z-scores adjusted for age for weight (WAZ), height (HAZ), and BMI (BMIZ) were categorized at age 10 years. To assess relationships between z-scores at 10 years and SDOH variables, we modeled all annual measurements for each z-score outcome using a multivariable mixed effects regression that included an interaction between the SDOH predictor and age. We included Hollingshead Score (HH) as a SDOH marker. A higher HH indicates better family socioeconomic status. Results: Of 555 subjects enrolled in the SVR trial, 191 had 10-year growth data. The mean WAZ and HAZ were below normal, with values of -0.3±1.3 (p&lt;0.001) and -0.8±1.2 (p=0.002), respectively. BMIZ did not differ from normal, with a mean value of 0.0±1.3 (p=0.87). WAZ and HAZ were &lt;-2 in 9% and 13%, respectively; BMIZ was &lt;-2 in 4% and &gt;2 in 5%. At birth [coefficient (95% CI)], only higher HH was associated with higher HAZ [0.01 (0.01,0.03), p=0.02]. On multivariable analysis, lower WAZ at 10 years was associated with higher HH [-0.02 (-0.03,0.01)], private insurance [-0.5 (-0.85,-0.16)], and father with college education [-0.64 (-1.06,-0.22)] (p&lt;0.04 for all). Lower BMIZ was associated with higher HH [-0.01 (-0.03,0)] and private insurance [-0.47 (-0.89,-0.04)] (p&lt;0.05 for all). No SDOH factors were independently associated with HAZ at 10 years. Conclusion: Higher SDOH, indicated by private insurance, higher HH and higher father’s education, was associated with lower WAZ and BMIZ at age 10 years. This may be reflective of the general population as children with lower SDOH are at risk for high BMI. It is reassuring that few were under- and over-weight. Survivor bias of children with higher SDOH may also be influencing these results; however, these findings deserve further exploration.

Sex Differences in Protein Biomarkers and Measures of Fat Distribution.

Sex differences in obesity and fat distribution may in part explain differences in cardiovascular risk in men versus women. We sought to examine sex differences in the associations of obesity and adiposity measures with cardiovascular disease-related protein biomarkers. In a cross-sectional observational cohort study, we examined whether the association of obesity (body mass index [BMI] and waist circumference) and adiposity measures (visceral adipose tissue) with biomarkers demonstrates effect modification by sex using multiplicative interaction terms in multivariable linear regression models. Among 3143 participants (mean age, 50 years; 49% women), sex modified the association of BMI, waist circumference, and visceral adipose tissue with cardiovascular disease-related protein biomarkers (7 for BMI, 3 for waist circumference, and 23 for visceral adipose tissue, false discovery rate [FDR]-qint<0.05 for all). For example, higher BMI was associated with lower α1-microglobulin levels in men but not in women (ß, -0.113; SE, 0.028; P<0.001 in men versus ß, -0.007; SE, 0.024; P=0.78 in women). By contrast, higher BMI was associated with higher adipsin levels in men and women, but the association was more pronounced in women (ß, 0.287; SE, 0.023; P<0.001 in women versus ß, 0.189; SE, 0.026; P<0.001 in men). The associations of higher visceral adipose tissue with biomarkers representing adiposity, inflammation, and fibrosis were more pronounced in women versus men. We found that sex modified the associations of obesity and adipose traits with cardiovascular risk ascertained by cardiovascular disease-related biomarkers including markers of adiposity, inflammation, and fibrosis. These findings highlight potential biological pathways that may underlie some of the observed differences in obesity-related cardiovascular disease between women and men.

Myosteatosis Evaluated Based on Intramuscular Adipose Tissue Content Is a Risk Factor for Postoperative Complications in Crohn's Disease.

Crohn's disease causes acute and chronic inflammation that often make the preoperative evaluation of surgical risks difficult. Myosteatosis is used for the evaluation of muscle quality to assess sarcopenia. However, data on the relationship between myosteatosis and surgical outcomes in patients with Crohn's disease are lacking. Among patients with Crohn's disease who underwent surgery between 2007 and 2022, we investigated the impact of myosteatosis on postoperative complications using intramuscular adipose tissue content (IMAC). Our study included data from 97 patients who underwent analysis for cutoff values and factors associated with IMAC and 72 who underwent analysis for risk factors of postoperative complications. Body mass index (BMI; P < .001) and visceral adipose tissue/height index (P < .001) were significantly correlated with IMAC. High BMI (P < .001) and a history of abdominal surgery for Crohn's disease (P = .012) were identified as factors affected with high IMAC. Multivariate analysis revealed high IMAC and external fistulas as independent risk factors for postoperative complications (odds ratio [OR], 5.010; 95% CI, 1.300-19.30; P = .019 and OR, 7.850; 95% CI, 1.640-37.50; P = .010, respectively), especially infectious complications. This study established IMAC as a valuable marker for sarcopenic obesity and predicting postoperative complications in patients with Crohn's disease. Furthermore, evaluating myosteatosis using IMAC will facilitate the decision of the optimal timing of surgery, prediction of complications, and treatment of sarcopenia in patients with Crohn's disease.

Factors Contributing to Early Recovery of Urinary Continence Following Radical Prostatectomy: A Narrative Review

Stress urinary incontinence (SUI) is a common condition in patients following radical prostatectomy (RP), which has a significant impact on all aspects of quality of life and is associated with significant social stigma. The factors that improve urinary incontinence in patients following surgery remain controversial. The aim of our narrative review was to identify and synthesise the latest evidence on pre-, intra- and post-operative factors and predictors that contribute to early continence recovery after RP. In this narrative review, primary resources were identified by searching PubMed, EMBASE and Medline, and secondary resources were collected by cross-referencing citations in the relevant articles. We started our review by searching for systematic reviews of factors and predictors that contribute to early recovery of urinary continence after RP. We then reviewed societal guidelines such as the American Urological Association and European Urological Association guidelines on male urinary incontinence. This review focuses on the pre-, intra and postoperative factors that influence postoperative SUI after RP, as well as highlighting modifications in surgical techniques that lead to early continence recovery. Increasing age, higher BMI, shorter membranous urethral length (MUL), and larger PV are independent prognostic factors for SUI within 3 months after RP. Factors such as modified surgical technique preservation of anatomical structure lead to influence postoperative early continence recovery. SUI after RP is influenced by various factors. These factors include not only anatomical landmarks and patient-related factors such as age, BMI, length of MUL and prostate volume, but also prior transurethral resection or laser enucleation of the prostate, the surgeon’s expertise, the surgical approach and NS technique.

Characteristics of adverse events recorded in various hospital wards: a case study of a level II referral specialist hospital

Abstract Aim. The aim of the study was to assess the incidence of selected adverse events and their characteristics in hospital wards with varying specialties at a Level II referral hospital in Kraków. Material and methods. The research was conducted at the Józef Dietl Specialist Hospital in Kraków on a group of 1272 patients who experienced an adverse event between 2013 and 2020. In order to answer the research questions, a retrospective analysis of the available medical records was performed in 2022 and statistical analyses were performed using the IBM SPSS Statistics package version 29. Results. The most frequent adverse events included falls, pressure sores and patient absconding. There were no statistically signifi cant diff erences in the age of patients experiencing adverse events. Women were more likely to experience falls without injury and the formation of pressure sores, while men were more likely to abscond from hospital. Higher BMI was observed in patients experiencing falls without injury. Conclusions. The risk of falls, both with and without injury, is a serious problem in hospitals. Although less common than falls, pressure sores are associated with longer hospitalisation and more frequently affect women. Seasonality and time of the day affect the type and frequency of adverse events. Differences between wards may indicate specific challenges related to the nature of patients.

Quantifying the Strain: A Global Burden of Disease (GBD) Perspective on Musculoskeletal Disorders in the United States Over Three Decades: 1990–2019

Background: Musculoskeletal (MSK) disorders significantly contribute to global disability, especially in high-income countries. Yet, comprehensive studies on their epidemiological burden in the United States (US) are limited. Our study aims to fill this gap by characterizing the MSK disease burden in the US using Global Burden of Disease (GBD) data from 1990 to 2019. Methods: We conducted an ecological study using descriptive statistical analyses to examine age-standardized prevalence and disability-adjusted life years (DALY) rates of MSK disorders across different demographics and states. The study also assessed the impact of risk factors segmented by age and sex. Results: From 1990 to 2019, the burden of MSK disorders in the US increased significantly. Low back pain was the most prevalent condition. Age-standardized prevalence and DALY rates increased by 6.7% and 17.6%, respectively. Gout and other MSK disorders saw the most significant rise in DALY rates. Females experienced higher rates than males, and there were notable geographic disparities, with the District of Columbia having the lowest and North Dakota and Iowa the highest DALY rates. Smoking, high BMI, and occupational risks emerged as primary risk factors. Conclusions: Our study highlights the escalating burden of MSK disorders in the US, revealing significant geographic and sex disparities. These findings highlight the urgent need for targeted health interventions, policy formulation, and public health initiatives focusing on lifestyle and workplace modifications. Region- and sex-specific strategies are crucial in effectively managing MSK conditions, considering the influence of various risk factors.

Alteration of the Gut–Lung Axis After Severe COVID-19 Infection and Modulation Through Probiotics: A Randomized, Controlled Pilot Study

Background: The gut–lung axis could be a potential therapeutic target for improving post-acute COVID-19 symptoms, and probiotics have been proposed as possible modulators. Aim: We conducted a pilot study to understand alterations in the gut–lung axis and to explore the effects of a probiotic in post-acute COVID-19 disease. Methods: We included patients after severe COVID-19 disease (sCOV, n = 21) in a randomized, placebo-controlled trial to test the effect of a probiotic (Pro-Vi 5, Institute Allergosan, Graz, Austria) in a six-month intervention and used patients after mild disease (mCOV, n = 10) as controls, to compare the intestinal microbiome, metabolome, and patient-reported outcomes and biomarkers along the gut–lung axis at baseline and throughout probiotic intervention. Results: Compared to mCOV patients, sCOV patients showed lower microbial richness, which was significantly improved by probiotic intervention. A reorganization of Ruminococcaceae and Lachnospiraceae taxa was observed in sCOV patients but remained unaffected by the intervention. Serum metabolome showed a dysregulation of lipoproteins in accordance with higher BMI and comorbidities in sCOV patients. HDL and LDL fractions/components were temporarily decreased in the probiotic group. Stool metabolome was altered at baseline in sCOV patients and an increase in L-DOPA after 3 months and butyrate after 6 months of intervention could be observed. Probiotics partially improved reduced quality of life and modulated altered immune responses in sCOV patients. Increased intestinal permeability at baseline remained unaffected. Conclusion: The study provides evidence of long-term alterations of the gut–lung axis after severe COVID-19 infection and suggests that probiotics can modulate the biomarkers of the gut–lung axis.