Higher Hemoglobin Research Articles

Metabolically healthy obesity and cardiovascular outcomes

Abstract Obesity increases cardiovascular risk through a deterioration of the metabolic profile. However, obesity is not always accompanied by a worsening metabolic profile. This longitudinal study aimed to determine whether obesity with a normal metabolic profile, i.e. metabolically healthy obesity, increases the risk of cardiovascular disease. We analyzed a health insurance data of Shizuoka prefecture resident. This data includes data from annual health check-ups performed for insured persons. This study analyzed data from 168,699 individuals aged <65 years. Obesity was defined as ≥ 25 kg/m2 body mass index. Metabolically healthy was defined as ≤ 1 metabolic risk factors (high blood pressure, low high-density lipoprotein cholesterol, high low-density lipoprotein cholesterol, or high hemoglobin A1c). Incidence rate of cardiovascular diseases (stroke and myocardial infarction), and all-cause mortality identified from the insurance data were compared between clinical profile-matched metabolically healthy obesity and non-obesity groups (n = 8,644 each). Clinical parameters, namely systolic blood pressure (standard mean difference = 0.03), HDL cholesterol (0.01), LDL cholesterol (0.01), and hemoglobin A1c (0.01) did not differ among the metabolically healthy obesity and non-obesity groups. The incident rate of stroke (obesity: 9.2 per 10,000 person-years; non-obesity: 10.5; log-rank test P = 0.595), myocardial infarction (obesity: 3.7; non-obesity: 3.1; P = 0.613), and all-cause mortality (obesity: 26.6; nonobesity: 23.2; P = 0.304) also did not differ significantly among the groups even when abdominal obesity was considered in the analysis, though the population with metabolically healthy obesity reported negligibly worse metabolic profiles than the population with nonobese at the 5.6-year follow-up. Obesity, when accompanied by a healthy metabolic profile, did not increase the risk of cardiovascular outcomes and all-cause mortality. Key messages • Metabolically healthy obesity did not increase cardiovascular disease risks. • Metabolically healthy obesity was associated with worse metabolic profiles after a few years later.

Diagnostic accuracy of a non-invasive spot-check hemoglobin meter, Masimo Rad-67® pulse CO-Oximeter®, in detection of anemia in antenatal care settings in Kenya.

Point of care hemoglobin meters play key roles in increasing access to anemia screening in antenatal care especially in settings with limited access to laboratories. We aimed to determine the diagnostic accuracy of a non-invasive spot-check hemoglobin (SpHb) meter, Masimo Rad-67® Pulse CO-Oximeter®, in the diagnosis of anemia in pregnant women attending antenatal care clinics in Kilifi, Kenya. This was a diagnostic accuracy study that retrospectively evaluated SpHb against a validated reference standard of laboratory assessed hemoglobin (Lab Hb) by a SYSMEX XN-330 automated hematology analyzer. The study was nested within a prospective pregnancy cohort study that recruited unselected pregnant women from antenatal care clinics in two public hospitals in Kilifi County, coastal Kenya. Records with both SpHb and Lab Hb were selected from pregnancy visits between May 2021 and December 2022. Linear regression and Bland-Altman analysis were performed to compare the two tests and diagnostic accuracy parameters obtained for the diagnosis of anemia. A total of 2,975 records (from 2,203 unique participants), with paired SpHb and Lab Hb were analyzed. Linear regression showed a significant but weak positive correlation, a proportional bias of 0.44 (95% CI 0.41-0.47) and a constant of 7.59 (95% CI 7.30-7.87, p < 0.001). The median bias was 1.70 g/dl, with limits of agreement of -0.80 to 4.20. SpHb tended to be higher than Lab Hb on the low hemoglobin range but lower than Lab Hb on the high hemoglobin range. The sensitivity of SpHb in detecting anemia was 18.66%. Prevalence, specificity, positive predictive value, and negative predictive values were 46.37%, 96.77%, 83.33%, and 57.92% respectively. Overall, SpHb by Masimo Rad-67® Pulse CO-Oximeter® did not accurately identify pregnant women with anemia and many cases would be missed. We would not recommend its use in antenatal care settings.

Elevated triglycerides and treatment eligibility in patients with severe, asymptomatic carotid stenosis: CREST 2 Trials

BackgroundData from the Centers for Disease Control show that approximately one-quarter of adults have elevated triglyceride (TG) levels. Some clinical trials, but not all, have demonstrated that pharmacologic treatment of high TG levels in patients already on statin therapy reduces the rate of major vascular events such as myocardial infarction and stroke. We assessed the prevalence of elevated TG levels in patients with asymptomatic carotid stenosis (CS), and medical conditions associated with high TG. MethodsBaseline lipid profiles from patients enrolled in the Carotid Revascularization and Medical Management for Asymptomatic Carotid Stenosis Trial (CREST 2) were analyzed. to determine treatment eligibility for high TG levels using the criteria established by the REDUCE-IT trial (triglyceride levels ≥150 mg/dL with LDL managed by a statin to <100 mg/dL). Equally assessed was the percentage of patients who were using pharmacologic treatment for high TG levels at study entry. Demographic factors and baseline medical conditions associated with high (>150 mg/dl) TG values were also analyzed. Chi-square and t=tests were used to assess baseline factors and abnormal TG values. ResultsAs of October 2023, of 2377 randomized CREST-2 patients, 2328 (98 %) (mean age 70.0 years, 63 % men) had baseline lipid profiles suitable for analysis. Among 1961 (84 %) patients who met REDUCE-IT criteria, analysis of lipid profiles revealed that 20.5 % of the patients were eligible for treatment of high triglycerides. Of the 1464 patients with fasting lipid profiles, 17.8 % were eligible for treatment. The median TG value was 205 (IQR 91) mg/dl in the total population. TG levels of 150 mg/dl or higher were strongly associated with hypertension, diabetes, obesity, high hemoglobin A1c, and reduced physical activity (all p<0.0001). ConclusionsElevated TG levels are strongly associated with diabetes, hypertension, obesity, and reduced physical activity. Further research is needed on whether treatment of elevated TG levels in patients with asymptomatic carotid stenosis confers benefit.

Dietary patterns related to attention and physiological function in high-altitude migrants.

High altitude exposure negatively affects human attentional function. However, no studies have explored the regulation of attentional and physiological functions from a dietary perspective. A total of 116 Han Chinese students from Tibet University who were born and raised in a plain area and had been living in Tibet for > 2 years were recruited. All participants were male migrants. A food frequency questionnaire, complete blood count, and attention network test were performed on the participants. Pearson's correlation was applied to assess the reliability and validity of the food frequency questionnaire. Principal component analysis was utilized to extract dietary patterns. A linear mixed model was employed to account for individual differences. The results showed that the five main dietary patterns were coarse grain, alcohol, meat, protein, and snacking dietary patterns. Furthermore, individuals who adhered to the coarse grain dietary pattern and had high mean corpuscular hemoglobin showed better attentional performance. Individuals with high alcohol consumption and systemic immune-inflammation index levels exhibited worse attentional performance. These findings imply that high-altitude migrants should include more coarse grains in their daily diet and avoid excessive alcohol consumption to improve attention.

Efficient purification of soluble receptor for advanced glycation end-products from Sus scrofa lung tissue and synthesis of its binding ligand, glycated bovine serum albumin

A receptor for advanced glycation end products (RAGE) has emerged as a crucial player in various pathological conditions due to its involvement in inflammation and cellular dysfunction. Its soluble isoform, sRAGE, has garnered significant attention for its competitive inhibitory effects and potential therapeutic applications. However, obtaining sRAGE with appropriate glycosylation patterns for binding to glycated proteins has been challenging, often requiring costly expression systems. Here, we present a novel approach for producing and purifying sRAGE from Sus scrofa lungs, bypassing the need for expensive expression systems. Previous protocols for sRAGE extraction faced reproducibility issues due to high viscosity and haemoglobin content of the solution. To address this, we developed a method for selective haemoglobin precipitation using a zinc-containing buffer, enabling purification via various chromatographic methods. Through a combination of chromatographic techniques, we obtained sRAGE in suitable purity, identified using HPLC-MS/MS. Additionally, producing glycated proteins for RAGE receptor activation often involved lengthy protocols or inadequate separation from reactants. Thus, we devised a rapid method for producing and purifying pure BSA glycated with ribose, addressing a critical gap in the field. Functional studies, conducted using Native PAGE, demonstrated the capability of purified proteins to bind to each other.

Retrospective evaluation of medical information for predicting tazobactam/piperacillin-induced liver injury.

Tazobactam/piperacillin is a first-line treatment option for hospital-acquired pneumonia; however, drug-induced liver injury (DILI) is relatively frequently observed with tazobactam/piperacillin in clinical practice. This study aimed to verify the usefulness of available patient data for predicting DILI prior to tazobactam/piperacillin administration. Tazobactam/piperacillin-treated patients were retrospectively selected and divided into patients with and without DILI. Comparative analysis was performed regarding age, gender, dose, duration of treatment, clinical laboratory values prior to treatment initiation, and the types of organ-specific infections in both groups. Multiple logistic regression analyses indicated that elevated C-reactive protein (odds ratio (OR), 1.284; 95% confidence interval (CI), 1.172 - 1.406; p < 0.001) and high hemoglobin (OR, 1.697; 95% CI, 1.259 - 2.286; p < 0.001) levels prior to the administration of tazobactam/piperacillin were risk factors for DILI in males who received a 4.5-g dose. A predictive model for DILI risk was constructed by combining these test values and analyzed using receiver operating characteristic curves, obtaining 0.910 for the model construction set and 0.845 for the validation set. The development of DILI was predicted with good accuracy in males who received a 4.5-g dose with elevated C-reactive protein and hemoglobin.

Prediction the Occurrence of Thalassemia With Hematological Phenotype by Diagnosis of Abnormal HbA1c.

The current investigation aims to analyze the occurrence of thalassemia in patients who participated in hemoglobin A1c (HbA1c) testing in clinical laboratory showing high hemoglobin F (HbF) level (≥ 1.5%) or abnormal Hb peak and predict the main influence factors by using different statistical models. The current investigation is a single-center retrospective cohort study. HbA1c concentration was detected by using TOSOH HLC-723G8 glycated hemoglobin analyzer. SNaPshot SNP (Single Nucleotide Polymorphism) typing and AccuCopy technology were employed to detect mutations in thalassemia-related pathogenic genes. A total of 126 patients endured high HbF levels or abnormal Hb peak during HbA1c detection, and 66.7% of subjects (n = 84) showed thalassemia mutations. Three heterozygosity mutations, including c.52A>T (p.K18*), c.-78A>G, and c.126_129delCTTT(p.F42Lfs*19) present in HBB gene, were also identified. --SEA/αα mutation demonstrated the youngest ages (p < 0.001). 17 M (p < 0.001) and 41/42 M (p < 0.01) mutations with β-thalassemia showed higher HbF levels compared with patients without thalassemia mutations. Except for -α3.7, mutations in thalassemia showed lower levels of mean corpuscular hemoglobin (MCH) and mean corpuscular volume (MCV) compared with patients without thalassemia mutations. Patients with thalassemia mutations showed younger age (p < 0.001), lower Hb (p < 0.001), MCV and MCH levels (p < 0.001), higher red blood cell (RBC)count (p < 0.001), and platelet distribution width (PDW) level (p = 0.007) than patients without thalassemia mutations. Three statistical models indicate MCV is the most valuable independent factor for predicting thalassemia and ROC (receiver operating characteristic) curves analysis of AUC (Area Under the Curve) of 0.855 (95% CI [0.787-0.923], p < 0.001) with MCV. High HbF level (≥ 1.5%) or abnormal Hb peak present in HbA1c testing indicated high incident rate of thalassemia. MCV is the most valuable independent predicting factor for subjects having thalassemia.

Predictors of major postoperative complications in cytoreductive surgery with or without hyperthermic intraperitoneal chemotherapy.

Cytoreductive Surgery (CRS) ± Hyperthermic Intraperitoneal Chemotherapy (HIPEC) is associated with a high incidence of postoperative morbidity. Our aim was to identify independent, potentially actionable perioperative predictors of major complications. We reviewed patients who underwent CRS ± HIPEC from June 2020 to January 2022 at a high-volume center. Postoperative complications were categorized using the Comprehensive Complication Index, with the upper quartile defining major complications. Multivariate logistic analysis identified predictive and protective factors. Of 168 patients, 119 (70.8%) underwent HIPEC. Mean Comprehensive Complication Index was 12.6 (12.7) and upper quartile cut-off was 22.6. Medical complications were more frequent but less severe than surgical (63% vs 18%). Forty-six patients (27.4%) comprised the "major complications" group (mean CCI 30.1 vs 6.3). Multivariate logistic regression showed that heart disease (RR 1.9; 95% CI: 1.1 to 3.3), number of anastomoses (RR 2.4; 95% CI:1.3 to 4.6) and first 24-h fluid balance (RR 1.1; 95% CI: 1.1 to 1.2), were independently associated as risk factors for major complications, while opioid-free anesthesia (RR 0.6; 95% CI: 0.3 to 0.9) and high preoperative hemoglobin (RR 0.9; CI 95%: 0.9 to 0.9) were independent-protective factors. Preoperative heart diseases, number of anastomoses and first 24h-fluid balance are independent risk factors for major postoperative complications, while high preoperative hemoglobin and opioid-free anesthesia are protective. Correction of anemia prior to surgery, avoiding positive fluid balance and incorporation of opioid-free anesthesia strategy are potential actionable measures to reduce postoperative morbidity.

A multicenter phase 2 clinical trial of low-dose subcutaneous decitabine in myelofibrosis

AbstractMyelofibrosis (MF) in the chronic phase is a challenging disease to treat, and conventional treatment options are geared toward symptom palliation. In this prospective, multicenter, phase 2 trial, 21 patients with MF (18 chronic phase, 2 accelerated phase, and 1 blast phase) were treated with a 10-day schedule of subcutaneous decitabine at 0.3 mg/kg per day. The overall response rate was 33% (95% confidence interval, 15-57), primarily manifested as an improvement in cytopenias. The median duration of response was 7 months (range, 3-44). A high International Prognostic Scoring System risk score, high baseline fetal hemoglobin level, and sustained decrease in circulating CD34+ cell counts were associated with response to decitabine. All patients experienced at least 1 grade 3/4 cytopenia. Nonhematologic toxicities were less frequent, with fatigue, anorexia, and hypocalcemia being the most common. Given the lack of effective therapies in MF with severe cytopenias, this study supports further investigation into the use of hypomethylating agents as single agents or in combination therapies. This trial was registered at www.ClinicalTrials.gov as #NCT00095784.

Association of haemoglobin glycation index with all-cause and cardiovascular disease mortality in diabetic kidney disease: a cohort study

BackgroundWhile the high haemoglobin glycation index (HGI) has been extensively investigated in diabetic populations, its impact on patients with diabetic kidney disease (DKD) remains unclear.MethodsWe examined data from the National Health and Nutrition Examination Surveys (NHANES) conducted between 1999 and 2018. HGI was determined using the formula recommended by Hempe et al., which calculates the difference between measured and predicted HbA1c. Predicted HbA1c was derived from the equation: 0.024 FPG + 3.1. National death index records up to December 31, 2019, were utilized to assess mortality outcomes. To estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for both all-cause and cardiovascular disease (CVD) mortality, we utilized Cox proportional hazard models. A restricted cubic spline analysis was performed to explore the potential nonlinear relationship between HGI levels and mortality.ResultsOur cohort study comprised data from 1,057 participants with DKD (mean [SE] age, 61.61 [0.57] years; 48.24% female). The mean HGI level was 0.44 (SE 0.04). Over a median follow-up period of 6.67 years, we observed 381 deaths, including 140 due to CVD. Compared with participants in the second tertile of HGI levels (0.03–0.74), those in the lowest tertile of HGI (-5.29–0.02) exhibited an all-cause mortality hazard ratio of 1.39 (95% CI, 1.02–1.88) and a CVD mortality hazard ratio of 1.10 (95% CI, 0.67–1.81). Conversely, participants in the highest tertile (0.75–9.60) demonstrated an all-cause mortality hazard ratio of 1.48 (95% CI, 1.05–2.08) and a CVD mortality hazard ratio of 2.06 (95% CI, 1.13–3.77) after further adjusting for HbA1c and other important variables. Additionally, a restricted cubic spline analysis revealed a U-shaped relationship between HGI and all-cause mortality (P < 0.001 for nonlinearity) and a J-shaped relationship between HGI and CVD mortality (P = 0.044 for nonlinearity).ConclusionsOur cohort study suggests that HGI in DKD populations exhibits a U-shaped association with all-cause mortality and a J-shaped association with CVD mortality, independent of HbA1c levels.

Impact of hemodialysis center accreditation on patient mortality: Korean nationwide cohort study.

Since hemodialysis (HD) patients are prone to various complications and high mortality, they need to be treated in HD units with professional personnel, proper equipment, and facilities. The Korean Society of Nephrology has been conducting an HD unit accreditation program since 2016. This study was performed to evaluate whether a qualified dialysis center (QDC) reduced the mortality of HD patients. This longitudinal, observational cohort study included 31,227 HD from 832 facilities. HD units were classified into two groups: the hospitals that have been certified as QDC between 2016 and 2018 (n = 219) and hospitals that have never been certified as QDC (non-QDC, n = 613). Baseline characteristics and patient mortality were compared between QDC vs. non-QDC groups using Korean HD quality assessment data from 2018. Multivariate logistic regression and the Cox proportional hazards model were used to compare patient mortality between the two groups. Among study subjects, 30.6% of patients were treated at QDC and 69.4% were treated at non-QDC. The patients in the QDC were younger and had a longer dialysis duration, lower serum phosphorus and calcium levels, and higher hemoglobin and single-pool Kt/V levels compared to the patients from the non-QDC group. After adjusting for demographic and clinical parameters, QCD independently reduced mortality risk (hazard ratio, 0.897; 95% confidence interval, 0.847-0.950; p < 0.001). The HD unit accreditation program may reduce the risk of death among patients undergoing HD.

U-shaped association between hemoglobin levels and albuminuria in US adults: a cross-sectional study.

This study aimed to explore the correlation between hemoglobin levels and albuminuria in US adults. This cross-sectional investigation analyzed the National Health and Nutrition Examination Survey (NHANES) information from 2011 to 2020. Data on hemoglobin, albuminuria, and other variables were collected from all participants. The logistic-regression analyses and smoothed curves were used to substantiate the research objectives. The average age of the 8,868 participants was 49.5 ± 17.3years, and 49.3% were men. The prevalence of albuminuria was 12.1%. After adjusting for potential variables in the logistic-regression analysis models, hemoglobin (per 1g/dL increase) was inversely associated with the presence of albuminuria (odds ratio [OR], 0.92; 95% confidence interval [95%CI], 0.87-0.97). Compared with participants in quartile 3 (Q3, 14.1-15.0g/dL) for hemoglobin levels, those in the lowest quartile 1 (Q1, 6.1-13.0g/dL) and highest quartile 4 (Q4, 15.1-19.6g/dL) had adjusted ORs for albuminuria of 1.48 (95% CI, 1.19-1.85) and 1.11 (95% CI, 0.9-1.38), respectively. Our observations indicated a U-shaped association between hemoglobin levels and albuminuria, with a point of inflection at approximately 15.5g/dL. The effect sizes and CIs below and above this point were 0.853 (95% CI, 0.798-0.912) and 1.377 (95% CI, 1.055-1.797), respectively. This study indicates that the presence of albuminuria is linked to both low and high hemoglobin levels in US adults. The management of hemoglobin may benefit kidney health.

P063 DIFFERENCES IN CARDIOVASCULAR RISK IN THE GENERAL POPULATION OF LOW AND HIGH-ALTITUDE RESIDENTS IN PERU. HIGH ALTITUDE CARDIOVASCULAR RESEARCH – LATIN AMERICA POPULATION STUDY

Background and Objective. Previous data in a convenience sample of highlanders showed an elevated prevalence of masked hypertension. However, comparative studies describing the prevalence of blood pressure (BP) phenotypes in the general population atof different altitudes are lacking. Our aim was to compare the prevalence of BP phenotypes defined by office BP measurement and ambulatory BP monitoring (ABPM) in a population-based sample of Peruvian lowlanders and highlanders. Methods. Sex- and age-stratified random general adult population sample was recruited in urban areas at low (Lima, &lt;500m) and high altitude (Huancayo 3287m, Juliaca 3824m, Cerro de Pasco 4330m). Questionnaires, anthropometric data, conventional BP (3 seated measurements with a validated oscillometric device), 24-hour ambulatory BP (A&amp;D TM2430, Japan), and blood analyses were obtained. BP was defined as elevated if either systolic or diastolic BP was: 1) office (OBP) ≥140/90; 2) 24-hour ≥130/80; 3) Daytime ≥135/85; 4) Night-time ≥120/70 (all in mmHg). BP phenotypes were defined as: normotension (NT) – no BP values elevated; white coat hypertension (WCH) – only OBP elevated; masked hypertension (MH) – any ambulatory BP elevated, normal OBP; sustained hypertension (SH) – OBP and any ambulatory BP elevated Results. The analysis included 181 lowlanders and 553 highlanders. Highlanders had slightly lower age (45 vs. 47 years, p=0.005), BMI (26.7 vs. 28.6 kg/m2, p&lt;0.001), and oxygen saturation (88.9 vs. 97.8%, p&lt;0.001) but higher haemoglobin (17.5 vs. 14.4 g/l, p&lt;0.001) than lowlanders. Prevalence of elevated OBP was low at high altitude. Elevated ambulatory BP was much more frequent at both altitudes. Consequently there was a high prevalence of masked hypertension, which was a dominating high BP phenotype among highlanders. Main results are reported in the Table. The altitude of residence remained independently associated with elevated 24-hour BP (p&lt;0.001) in a multiple logistic regression model including age, sex and BMI as covariates. Conclusions. Many individuals in Peru, especially highlanders, are exposed to BP-related risk, which cannot be captured by office measurements alone.

Hemoglobin A1c Levels Are Related to Patency and Adverse Limb Events in Diabetics After Revascularization

Poor glycemic control in the perioperative period has been reported to be associated with early and late major adverse limb events (MALEs). However, these studies were mostly from large databases or lacked long-term outcomes. We examined the long-term effects of high hemoglobin A1c (HbA1c) level on patency, MALE, limb salvage (LS) and survival after lower extremity revascularization procedures in patients with diabetes. Patients with diabetes who underwent revascularization for Rutherford class 3 to 6 ischemia between May 2002 and December 2018 were identified. Patients with an HbA1c of ≤7% were compared with those with an HbA1c of >7% for patency, MALE, survival, LS, and amputation-free survival. Of 706 patients, 699 had HbA1c data (775 limbs), with 311 (357 limbs) in the HbA1c ≤7% and 388 (418 limbs) in the HbA1c >7% groups. Patients with an HbA1c of >7% were younger (69.9± 10.2 years vs 71.7± 9.5 years; P= .011), had higher lipid levels, insulin use (70% vs 49%; P< .01), American Society of Anesthesiologists classification of 4, and had a lower prevalence of chronic kidney disease (32% v s41%; P= .023). Patients with an HbA1c of >7% were more likely to present with chronic limb-threatening ischemia (CLTI) (79% vs 72%; P= .019) and undergo infrapopliteal interventions (49% vs 42%; P= .005), with no difference in anatomical complexity (TransAtlantic Inter Society Consensus class C/D, 75% vs 77%; P= .72) or type of revascularization (24% vs 18% open, 66% vs 70% endovascular, 10% vs 12% hybrid; P= .236). Patency and freedom from MALE were significantly lower in patients with an HbA1c of >7% for infrainguinal revascularizations, whereas amputation-free survival and overall survival were similar. In patients with chronic limb-threatening ischemia, LS rates at 5 years were significantly lower in patients undergoing open revascularization (HbA1c > 7%: 64%± 6% vs HbA1c<7%:86%± 5%; P= .020), whereas it was similar after endovascular interventions (HbA1c > 7%:79%± 4% vs HbA1c< 7%:77%± 3%; P= .631). Seventy patients with an HbA1c of >7% lost limbs vs 38 patients with an HbA1c of ≤7% (P= .007). In multivariate analysis, HbA1c was associated significantly with primary patency. HbA1c, insulin use, level of intervention, and angiotensin-converting enzyme inhibitor use were associated with MALE. A perioperative HbA1c of >7% is associated with poorer patency rates and increased MALE, especially at the infrainguinal level revascularization in patients with diabetes, with no significant impact on survival. LS is impacted after open, but not after endovascular revascularization.

Prevalence of Non-Alcoholic Fatty Liver Disease and Its Impact on Fibrosis Risk in Inactive Chronic Hepatitis B Patients: Insights from a Cross-Sectional Study.

Background: Chronic hepatitis B (CHB) and non-alcoholic fatty liver disease (NAFLD) are significant causes of chronic liver disease, potentially leading to liver cirrhosis and hepatocellular carcinoma. Moreover, the coexistence of CHB and NAFLD is increasingly common, although the relationship between NAFLD and inactive CHB infection remains poorly understood. Objectives: This study aimed to investigate the prevalence of NAFLD among patients with inactive CHB, identify risk factors for NAFLD, and determine predictors of significant fibrosis in these patients. Methods: This single-center cross-sectional study targeted patients with inactive CHB at Sultan Qaboos University Hospital from January 2010 to November 2021. Results: A total of 425 patients with inactive CHB were identified, of which 53.1% were male and 62.6% were aged 40-60 years. The prevalence of NAFLD was 47.8%. Various independent factors were associated with NAFLD, including type 2 diabetes mellitus, elevated low-density lipoprotein levels, high hemoglobin levels, low platelet counts, and normal alpha-fetoprotein levels. Significant associations were noted between NAFLD and significant fibrosis, with 10.5% of CHB patients with NAFLD exhibiting significant fibrosis compared to 1.4% of those without NAFLD. Other significant parameters included male gender, increased age, high alanine transaminase levels, elevated hemoglobin, and decreased platelet levels. Conclusions: The high prevalence of NAFLD in patients with inactive CHB and its associations with increased fibrosis and cirrhosis risk underscore the need for comprehensive management strategies for these patients.

The Influence of Environmental Conditions and Coinfection by Blood-Feeding Parasites on Red Blood Cell Physiology of an Ectothermic Host.

AbstractVector-borne blood parasites cause myriad sublethal effects and can even be deadly to endotherms, but far less is known about their impacts on ectothermic hosts. Moreover, the pathologies documented in endotherms are generally linked to infection by blood parasites rather than by their vectors. Here, we measured hematocrit, hemoglobin, and relative proportions of immature red blood cells to evaluate the physiological effects of two blood-feeding parasites and coinfection on ectothermic hosts, differentiating among pathological responses, extrinsic factors, and natural variations. We investigated a population of wild eastern hellbender salamanders (Cryptobranchus alleganiensis), which harbor leeches (Placobdella appalachiensis) that transmit blood parasites (Trypanosoma spp.) to their hosts, often resulting in coinfection. We observed seasonal changes in host hematology corresponding to water temperature and demonstrated their ability to modulate hematological parameters in response to acute stress. We reveal seasonal relationships between parasite dynamics and host physiology, in which peak parasitemia occurred when hosts had seasonally high hematocrit and hemoglobin concentrations. We found that coinfected individuals expressed symptoms of anemia, including a regenerative response to depletion of their red blood cells. We also documented a more pronounced pathological response to leech vectors than to the trypanosomes they transmit. Our research underscores the complex interactions between host physiology, multiple parasites, and environmental factors and highlights the pathologies associated with the vector in coinfections. Given the contributions of climate change and disease in the rapid global decline of ectotherms such as amphibians, our study provides timely foundational insights into multiple factors that influence their red blood cell physiology.

Regulatory role of ETS1 transcription factor in hemocytes proliferation in Anadara granosa

The ETS1 transcription factor is crucial in the process of biological development. In vertebrate, ETS1 plays a pivotal role in promoting endothelial cell proliferation and angiogenesis. However, the identity and function of ETS1 remains unclear in mollusks. In this study, an ETS1 homolog (named as AgETS1) was identified in blood clam Anadara granosa (synonym: Tegillarca granosa). The full length of the AgETS1 transcription factor is 1569 bp, consisting of 539 amino acids, including the Sterile Alpha Motif (SAM) domain, which can recognize and bind to sequence of GGAA. Tissue expression analysis of A. granosa showed that AgETS1 exhibits the highest expression level in the gill tissues (51.5-fold of that in hemocyte, p < 0.05). AgETS1 mRNA transcripts were predominantly expressed during larval development, from zygote to trochophore stage. Moreover, the expression levels of AgETS1 in blood clams with high hemoglobin concentration (hemocyte count >1.75 × 108 cells/mL) were significantly higher than that in blood clams with low hemoglobin concentration (hemocyte count <8.5 × 107 cells/mL) (p < 0.05). RNA interfering (RNAi) of AgETS1 induced a corresponding decrease in the number of hemocytes in the hemolymph and a reduction in EdU-marked proliferating cells in the gill tissue. These results indicated that the ETS1 actively regulated the proliferation of hemocytes in A. granosa.

Anaemia among school-going adolescents in Burkina Faso: Prevalence and associated factors.

Adolescence, a stage of growth between 10 and 19 years, is a transitional period of intense cognitive, emotionaland physical development. Though iron deficiency is theleading cause of morbidity and mortality among this age group, nutritional interventions targeting adolescents are rare. To inform policy and practice aimed at adolescent health, we established the burden of anaemia among school-going adolescents in Center West Burkina Faso and investigated the potential explanatory factors. A cross-sectional survey was conducted between January and March 2021. Blood samples, socio-demographic, socioeconomic, anthropometric, dietaryand water, sanitation and hygiene data from 2947 students aged 10-18 years were collected. Anaemia was determined by the World Health Organization's sex- and age-specific haemoglobin concentrations. χ2 tests and logistic regressions were used to identify factors associated with anaemia. The prevalence of anaemia among adolescents in the sample was 36.2%, including 24.2% mild, 11.6% moderateand 0.4% severe anaemia. Compared to males, females were 19% less likely to have mild anaemia (adjusted Odds Ratio [aOR] = 0.81; 95% confidence intervals [CI]: 0.689, 0.955) but 42% more likely to be moderately or severely anaemic (aOR = 1.42; 95% CI: 1.102, 1.831). Among iron-rich foods, tamarind (aOR = 0.75; 95% CI: 0.610, 0.929) and pumpkin leaves (aOR = 0.77; 95% CI: 0.605, 0.974) were associated with lower odds of anaemia. Several water, sanitation and hygiene factors were associated with higher haemoglobin, including handwashing after toilet use (β = 0.50; 95% CI: 0.031, 0.966)andtooth brushing twice daily (β = 0.19; 95% CI: 0.030, 0.354). Anaemia among adolescents in Burkina Faso should be addressed with interventions targeting diet, sanitationand hygiene.

Predictive factors of postoperative complications related to free flap reconstruction in head and neck cancer patients admitted to intensive care unit: a retrospective cohort study

BackgroundThe epidemiology and risk factors for postoperative complications related to free flap reconstruction in head and neck cancer patients admitted to the Intensive Care Unit (ICU) are unknown.MethodsWe performed a retrospective cohort study of patients with free flap reconstruction of head and neck cancer between September 2015 and April 2023 admitted to the ICU of Beijing Tongren Hospital. The univariate and multivariate analyses were used to explore the risk factors for postoperative complications related to free flap reconstruction admitted to ICU, including flap necrosis, bleeding, fistula, and infection.ResultsA total of 239 patients were included in this study, and 38 (15.9%) patients had postoperative complications related to free flap reconstruction. The median length of ICU stay was 1 day (interquartile range, 1–2 days). Multivariate analysis found that low BMI (P < 0.001), high postoperative CRP (P = 0.005), low hemoglobin (P = 0.012), and inadequate fluid intake (P < 0.05) were independent risk factors for complications.ConclusionsPostoperative complications related to free flap reconstruction were common in this ICU population. Careful fluid management and monitoring of CRP and hemoglobin levels may reduce complications.

A Propensity-Matched Cohort Study of Intravenous Iron versus Red Cell Transfusions for Preoperative Iron-Deficiency Anemia.

While preoperative anemia is associated with adverse perioperative outcomes, the benefits of treatment with iron replacement versus red blood cell (RBC) transfusion remain uncertain. We used a national database to establish trends in preoperative iron-deficiency anemia (IDA) treatment and to test the hypothesis that treatment with preoperative iron may be superior to RBC transfusion. This study is a propensity-matched retrospective cohort analysis from 2003 to 2023 using TriNetX Research Network, which included surgical patients diagnosed with IDA within 3 months preoperatively. After matching for surgery type and comorbidities, we compared a cohort of patients with preoperative IDA who were treated with preoperative intravenous (IV) iron but not RBCs (n = 77,179), with a cohort receiving preoperative RBCs but not IV iron (n = 77,179). Propensity-score matching was performed for age, ethnicity, race, sex, overweight and obesity, type 2 diabetes, hyperlipidemia, essential hypertension, heart failure, chronic ischemic heart disease, neoplasms, hypothyroidism, chronic kidney disease, nicotine dependence, surgery type, and lab values from the day of surgery including ferritin, transferrin, and hemoglobin split into low (<7 g/dL), medium (7-<12 g/dL), and high (≥12 g/dL) to account for anemia severity. The primary outcome was 30-day postoperative mortality with the secondary outcomes being 30-day morbidity, postoperative hemoglobin level, and 30-day postoperative RBC transfusion. Compared with RBC transfusion, preoperative IV iron was associated with lower risk of postoperative mortality (n = 2550/77,179 [3.3%] vs n = 4042/77,179 [5.2%]; relative risk [RR], 0.63, 95% confidence interval [CI], 0.60-0.66), and a lower risk of postoperative composite morbidity (n = 14,174/77,179 [18.4%] vs n = 18,632/77,179 [24.1%]; RR, 0.76, 95% CI, 0.75-0.78) (both P = .001 after Bonferroni adjustment). Compared with RBC transfusion, IV iron was also associated with a higher hemoglobin in the 30-day postoperative period (10.1 ± 1.8 g/dL vs 9.4 ± 1.7 g/dL, P = .001 after Bonferroni adjustment) and a reduced incidence of postoperative RBC transfusion (n = 3773/77,179 [4.9%] vs n = 12,629/77,179 [16.4%]; RR, 0.30, 95% CI, 0.29-0.31). In a risk-adjusted analysis, preoperative IDA treatment with IV iron compared to RBC transfusion was associated with a reduction in 30-day postoperative mortality and morbidity, a higher 30-day postoperative hemoglobin level, and reduced postoperative RBC transfusion. This evidence represents a promising opportunity to improve patient outcomes and reduce blood transfusions and their associated risk and costs.