Independent Association Research Articles

The Impact of Travel Distance in Patient Outcomes Following Revascularization for Chronic Limb-Threatening Ischemia

Patient travel distance to the hospital is a key metric of individual and social disadvantage and its impact on the management and outcomes following intervention for chronic limb-threatening ischemia is likely underestimated. We sought to evaluate the effect of travel distance on outcomes in patients undergoing first time lower extremity revascularization at our institution. We retrospectively reviewed all consecutive patients undergoing first-time lower extremity revascularization, both endovascular and open, for CLTI from 2005 to 2014. Patients were stratified into 2 groups based on travel distance from home to hospital greater than or less than 30 miles. Outcomes included reintervention, major amputation, restenosis, primary patency, wound healing, length of stay, length of follow-up and mortality. Kaplan-Meier estimates were used to determine event rates. Logistic and cox regression was used to evaluate for an independent association between travel distance and these outcomes. Of the 1,293 patients were identified, 38% traveled more than 30 miles. Patients with longer travel distances were younger (70 vs 73 years, P=0.001), more likely to undergo open revascularization (65% vs 41%, P<0.001), and had similar WifI stages (P=0.404). Longer distance travelled was associated with an increase in total hospital length of stay (9.6 vs 8.6 days, P=0.031) and lower total length of post-operative follow-up (2.1 vs 3.0 years, P=0.001). At 5-years, there was no definitive difference in the rate of restenosis (HR 1.3[0.91-1.9, P=0.155) or reintervention (HR 1.4[0.96-2.1, P=0.065), but longer travel distance was associated with an increased rate of major amputation (HR 2.1[1.2-3.7], P=0.011), and death (HR 1.6[1.2-2.2], P=0.002). Longer travel distance was also associated with higher rate of non-healing wounds (HR 2.3[1.5-3.5], P=0.001). Longer patient travel distance was found to be associated with a lower likelihood of limb salvage and survival in patients undergoing first-time lower extremity revascularization for chronic limb-threatening ischemia. Understanding and addressing the barriers to discharge, need for multidisciplinary follow-up, and appropriate post-operative wound care management will be key in improving outcomes at tertiary care regional specialty centers.

Antineutrophil cytoplasmic antibody is an independent risk factor in rheumatoid arthritis-associated interstitial lung disease

ObjectivesThis study aimed to investigate the clinical relevance of antineutrophil cytoplasmic antibody (ANCA) in patients with rheumatoid arthritis-associated interstitial lung disease (RA-ILD). MethodsDetailed clinical records of rheumatoid arthritis (RA) patients who underwent ANCA screening tests were collected. ANCA measurements were determined by indirect immunofluorescence assay (IIF) and enzyme-linked immunosorbent assay (ELISA). Clinical characteristics were compared between ANCA-positive and ANCA-negative groups, and multivariable logistic models were used to evaluate the independent association of ANCA with ILD in RA patients. ResultsThe prevalence of ANCA by IIF was significantly higher in RA-ILD patients compared to those with RA without ILD (31.7 % vs. 19.5 %, p < 0.001). RA-ILD patients positive for ANCA exhibited elevated levels of inflammatory markers and greater disease activity, and showed more severe impairment of lung function compared to ANCA-negative RA-ILD patients. Multivariable logistic regression analysis revealed an independent association of ANCA, especially pANCA, with RA-ILD. ANCA specificities for BPI, elastase, and cathepsin-G were found in 15.6 % of RA-ILD patients; the specificities for most others remain unknown. ConclusionsThe findings suggest a potential role for ANCA/pANCA in stratifying the risk of RA and provide supplementary information to the existing clinically available assays. This additional information may be valuable in identifying RA patients who require further investigations for RA-ILD, such as high-resolution computed tomography (HRCT). These results emphasize the potential clinical relevance of ANCA in the context of RA-ILD.

Importance of Surgeon’s Experience in Practicing Valve-Sparing Aortic Root Replacement

ObjectiveValve-sparing root replacement (VSRR) requires a unique skill set. This study aims to examine the influence of surgeon’s procedural volume on outcomes of VSRR. MethodsThis is retrospective study of 1697 patients from two large, high-volume aortic centers who underwent aortic root replacement (ARR) from 2004 to 2021 and were potentially eligible for VSRR. Surgeons were classified as having performed <5 ARR or ≥5 ARR annually. Multivariable logistic regression was used to examine the independent association of surgeon volume and decision to perform VSRR. Inverse probability treatment weighting (IPTW) was used to match patients who were operated on by <5 ARR or ≥5 ARR surgeons and compare long term survival probability. Cumulative incidence curves with mortality as a competing risk were plotted to compare the rate of aortic valve reoperation. ResultsOf 1697 patients who met inclusion criteria, 944 patients underwent composite-valved conduit (CVC) ARR and 753 underwent VSRR. The median age of our cohort was 57 [45-66] years old and 268 (15.8%) were female. Aortic insufficiency (AI) was present in 1105 (65.1%) of patients and 200 (11.8%) of cases were a reoperation. Surgical indication was aneurysm in 1496 (88.2%) and dissection in 201 (11.8%) of patients. Among VSRR operations, 691/753 (92%) patients were operated on by ≥5 ARR surgeons and 62/753 (8%) patients were operated on by <5 ARR surgeons. In multivariable logistic regression, ≥5 ARR (OR: 3.33, 95% CI: 2.34-4.73, p <0.001) was associated with VSRR as a procedure of choice. Following IPTW, there was no significant difference in survival probability after VSRR between <5 ARR and ≥5 ARR surgeons (p = 0.59). There was also no significant difference in the rate of aortic valve reoperation (p = 0.6). ConclusionsIn the context of a high-volume aortic center, patients who undergo ARR are less likely to receive VSRR if operated on by a <5 ARR surgeon; however, VSRR may be safely performed by a <5 ARR surgeon.

Association between Albumin-Bilirubin score and in-hospital Mortality in patients with Sepsis: Evidence from Two Large Databases.

BackgroundThe Albumin-Bilirubin (ALBI) score, recommended for assessing the prognosis of hepatocellular carcinoma patients, has garnered attention. The efficacy of ALBI score in forecasting the risk of death in sepsis patients remains limited. We designed two cohort studies to assess the association between ALBI score and in-hospital mortality in patients with sepsis. MethodsA retrospective analysis was conducted utilizing data from the Second Affiliated Hospital of Guangzhou Medical University and the Medical Information Mart for Intensive Care IV(MIMIC-IV). Patients diagnosed with sepsis were included in the analysis. The primary outcome was the in-hospital mortality. Multivariate Cox regression analysis was conducted to assess the independent association between the ALBI score and mortality, with adjustment for potential confounders. Subgroup analysis was conducted to assess the robustness of the findings. ResultsThe Guangzhou Sepsis Cohort (GZSC) of the Second Affiliated Hospital of Guangzhou Medical University comprised 2969 participants, while the MIMIC-IV database included 8841 participants. The ALBI score were categorized into <-2.60, -2.60∼-1.39, and >-1.39. After adjusting for confounders, a linear relationship was observed between ALBI score and mortality. Patients with a high ALBI grade were associated with higher in-hospital mortality in both the GZSC (HR: 1.52, 95%CI: 1.24-1.87, p < 0.001) and the MIMIC-IV database (HR: 1.57, 95%CI: 1.46-1.70, p < 0.001). ConclusionsA high ALBI score is associated with higher in-hospital mortality among sepsis patients in ICU.

Carboxyhemoglobin as Potential Biomarker for Cardiac Surgery Associated Acute Kidney Injury

ObjectivesCarboxyhemoglobin (CO-Hb) is a marker of hemolysis and inflammation, both risk factors for cardiac surgery-associated AKI (CSA-AKI). However, the association between CO-Hb and CSA-AKI remains unknown. DesignA retrospective cohort study. SettingTertiary university-affiliated metropolitan hospital: single center. ParticipantsAdult on-pump cardiac surgery patients from July 2014 to June 2022 (n=1698). InterventionsNone. Measurements and Main ResultsPatients were stratified into quartiles based on CO-Hb levels at intensive care unit (ICU) admission. A progressive increased risk of CSA-AKI was observed with higher CO-Hb levels at ICU admission. On multivariate logistic regression analysis, the highest quartile (CO-Hb ≥1.4%) showed an independent association with the occurrence of CSA-AKI (odds ratio=1.45 compared to the lowest quartile (CO-Hb<1.0%), 95% CI 1.023-2.071; p=0.038). Compared to patients with CO-Hb <1.4%, patients with CO-Hb ≥1.4% at ICU admission had significantly higher postoperative creatinine (135 vs 116 μmol/L, p<0.001), higher rates of postoperative RRT (6.7% vs 2.3%, p<0.001) and AKI (p<0.001) on univariate analysis and shorter time to event for AKI or death (p<0.001). ConclusionsCO-Hb ≥1.4% at ICU admission is an independent risk factor for CSA-AKI, which is easily obtainable and already available on routine arterial blood gas measurements. Thus, CO-Hb may serve as a practical and biologically logical biomarker for risk stratification and population enrichment in trials of CSA-AKI prevention.

한국의 기독교 선교가 독립운동에 미친 영향

The purpose of this study was to look at the devaluation of Christianity and its alienation from the people and ask, “What is the meaning of Christianity being introduced into Korean society, and what impact has it had?”. In the process of accepting Christianity, the analysis focused on political and social situations, economic and religious situations as acceptance factors. Politically and socially, the pressure for reform and opening by Western powers, the signing of treaties, and the introduction of new systems were analyzed. In terms of the economic situation, the economic impoverishment suffered by the people of countries that failed to adapt to world historical changes and quickly accept the culture of modernization explained. In addition, referring to the suppression of Catholicism in the process of introducing Catholicism and the failure of the Catholic introduction process in the religious situation, various methods were tried and the situations in which the gospel was gradually spread were explained. It was pointed out that Christianity had a great influence on the modernization of Korea during the Enlightenment period, including the spirit of patriotism and love for the people, prohibition of discrimination between people and books, and the abolition of the caste system. In addition, the fundamental reason for the acceptance of Christianity was that it was recognized as a powerful religion that made wealth possible, and thus the gospel expanded from the powerless ruled class to the ruling class. Meanwhile, Christianity had a great influence on the March 1st Independence Movement, and the changes in the consciousness of the Joseon people due to Christian missions were examined through the establishment of independence association branches, differences in active participation, and a confession written by a nobleman. In addition, we looked into the teachings of Christianity, focusing on the subject of the independence movement, the purpose of the movement, and the methods of action in the independence movement as shown in the Declaration of Independence, and the relationship between Christianity and the role of the March 1st Movement and Christian schools. Lastly, it concludes that in the face of the decline of Christianity, which had a great influence during the turbulent times of Korean history, the Korean people need to know and learn about history.

Association between non-alcoholic fatty liver disease and the risk of pulmonary nodules in patients with intestinal polyps.

Associations between metabolic risk factors and lung cancer remain elusive, and evidence on the linkage between non-alcoholic fatty liver disease (NAFLD) and pulmonary nodules is limited. This study sought to examine the independent association between NAFLD and the risk of pulmonary nodules. Cross-sectional analyses of 1,119 patients with intestinal polyps hospitalized at the Department of Gastroenterology, Minhang District Central Hospital of Shanghai, China, were conducted. NAFLD was diagnosed based on hepatic ultrasonography or computed tomography (CT) findings of hepatic steatosis, with exclusion criteria ensuring patients had no history of significant alcohol consumption, viral infections, or hepatic autoimmune diseases. The currently accepted definition of a pulmonary nodule is a solid or sub-solid shadow ≤3 cm in diameter that appears as a solid or semi-solid pattern on a chest CT scan (our specific treatment is pulmonary nodule size: 5 mm to 3 cm). Adjusted 95% confidence intervals (CIs) and odds ratios (ORs) for NAFLD and the clinical features connected with pulmonary nodule risk were determined using a multivariable logistic regression analysis. Among the 979 intestinal polyp patients, the prevalence rates of NAFLD and pulmonary nodules were 25.9% and 32.8%, respectively. Patients with pulmonary nodules exhibited higher rates of NAFLD (31.5% vs. 23.3%, P=0.006) and obesity (41.4% vs. 32.5%, P=0.006) compared to those without pulmonary nodules. After removing all the possible confounding variables, the adjusted ORs for NAFLD, an older age, smoking, and obesity were 1.370 (95% CI: 1.006-1.867, P=0.04), 1.022 (95% CI: 1.010-1.033), 1.599 (95% CI: 1.033-2.475), and 1.410 (95% CI: 1.057-1.880), respectively (all P values <0.05). NAFLD showed a significant association with an increased risk of pulmonary nodules. NAFLD was independently linked to an increased incidence of pulmonary nodules in intestinal polyp patients, which emphasizes the importance of screening and managing these conditions in lung cancer prevention.

Visceral adiposity index, fitness and clustered cardiovascular disease risk in adolescents.

Clustering of cardiovascular disease (CVD) risk factors have been observed in children and adolescents, but its association with visceral adiposity index (VAI) and cardiorespiratory fitness (CRF) in adolescents has rarely been studied. This study determines the independent associations of VAI and CRF with the clustering of cardiovascular disease risk (CVDr) among Nigerian adolescents. Adolescents from specific secondary schools in Kogi East, North Central Nigeria participated in the study. A cross-sectional sample of 403 adolescents (202 boys and 201 girls) aged 11 years - 19 years were evaluated for VAI, CRF and CVDr. Using identified risk factors, a clustered CVDr score was generated. The association between VAI, CRF and clustered CVDr was evaluated using regression models that controlled for age, gender and maturity status. Fitness was negatively associated with CVDr (β= -0.268,p 0.001), while VAI was positively correlated with CVDr (β= 0.379,p 0.001). After CRF or VAI adjustment, the independent association with the dependent variable remained significant. The odds of an adolescent with elevated VAI being at risk of CVD was 4.7 times higher than his peers. Unfit adolescents were 2.1 times more likely to develop CVDr. Both VAI and CRF were independently associated with the clustering of CVDr in Nigerian adolescents. The findings suggest that health promotion efforts focusing on healthy diet and aerobic-type physical activity programmes should be encouraged among the youth to reduce the risk of CVD.Contribution:This study shows that improving visceral adipose tissue and fitness may lower CVD risk factors in adolescents, which is significant for public health.

The association of insertion methods on immediate postpartum intrauterine device expulsion rates: A retrospective cohort study

ObjectiveTo evaluate the method of immediate postpartum IUD (ppIUD) insertion (manual versus ring forceps) and expulsion rate within 6-week postpartum. Study designWe performed a retrospective cohort study of patients who had a singleton vaginal delivery and an immediate ppIUD inserted at Rush University from January 2014 to September 2023. The primary outcome was rate of expulsion within 6-week postpartum. We compared the rate of expulsion by method of insertion, either using a manual technique versus using ring forceps. We performed univariable analysis for the association between baseline maternal characteristics and the primary outcome and we performed multivariable logistic regression to determine the independent association of the method of insertion and the primary outcome. ResultsTwo hundred nineteen patients met eligibility with 117 immediate ppIUDs inserted manually and 102 inserted with ring forceps. Baseline maternal demographics were similar across study groups. After adjusting for factors selected a priori (estimated blood loss, body mass index, gestational age at delivery, nulliparity, type of IUD), use of ring forceps was more likely to result in expulsion compared to manual insertion (30.4% vs 16.2% respectively; adjusted OR 2.49, 95% confidence interval 1.28–4.90). ConclusionIn this retrospective analysis, insertion of immediate ppIUD with ring forceps was independently associated with an increased rate of expulsion within 6 weeks postpartum when compared to manual insertion. ImplicationsIn this setting, ring forceps was associated with high rates of immediate postpartum IUD expulsion compared to manual technique. Studies disagree, suggesting need for additional work.

Association of Area Deprivation Index with Adherence to Proposed Regimen in Patients with Sarcoidosis in Detroit, Michigan.

Social predictors affect severity of sarcoidosis, with Black patients, older individuals, those with lower income, and those without insurance having greater severity. This study aimed to explore potential disparities affecting access to care in sarcoidosis patients with a primary focus on metrics such as area deprivation index (ADI) and its association with adherence to the proposed regimen. A retrospective chart review study of all patients seen in pulmonary clinics at a large urban tertiary care center over 2 years with sarcoidosis patients identified with International Classification of Diseases diagnosis code D86. Data collected included age, race, sex, ADI, insurance, online patient portal usage, chest x-rays, pulmonary function tests, missed visits, hospitalizations, positive biopsy, communication and visits around bronchoscopy. Categorical variables were described using frequency and percentage. Numerical variables were described using median, mean and standard deviation. Statistical analysis included chi-square test, two-sample T-test and Wilcoxon rank sum test. Multivariate logistic regression analysis was performed to model independent association with 12 month no-show occurrence as a metric of adherence to the proposed regimen. Among sarcoidosis patients (N = 788), univariate models showed the presence of active online patient portal use among younger patients (58.6 years with portal vs. 65.1 years without portal, p < 0.001), those with lower ADI (73 with portal vs. 92 without portal, p < 0.001) and with commercial insurance (48.5% with portal vs. 20.7% without portal, p < 0.001); more x-rays (45.6% with x-rays vs. 36.6% without x-rays, p = 0.018) and hospitalizations (50.3% with hospitalizations vs. 36.2% without hospitalizations, p < 0.001) in Medicare patients. Sarcoidosis patients with positive biopsies on file from 2013-2023 were more likely to be male (44.19% with positive biopsy vs. 33.91% without positive biopsy, p = 0.006), White (36.29% with positive biopsy vs. 22.9% without positive biopsy, p < 0.001) or other races (3.23% with positive biopsy vs. 2.25% without positive biopsy, p < 0.001), younger (55.8 years with positive biopsy vs. 61.7 years without positive biopsy, p < 0.001) and belonged to lower national ADI ranks (73 with positive biopsy vs. 80 without biopsy, p = 0.041). A multivariate analysis was done with those variables found to be significant in the univariate analyses, which revealed that higher ADI national was associated with failure to adhere to the proposed regimen. We identified intricate patterns of sociodemographic variables affecting access to care in sarcoidosis patients, especially higher ADI national associated with failure to adhere to the proposed regimen, raising concerns for potential healthcare barriers. Understanding these barriers is vital for equitable high-quality care, assisting in timely and efficient management of the patient's disease.

Measures of wave intensity as a non-invasive surrogate for cardiac function predicts mortality in haemodialysis patients.

Risk prediction in haemodialysis (HD) patients is challenging due to the impact of the dialysis regime on the patient's volume status and the complex interplay with cardiac function, comorbidities and hypertension. Cardiac function as a key predictor of cardiovascular (CV) mortality in HD patients is challenging to assess in daily routine. Thus the aim of this study was to investigate the association of a novel, non-invasive relative index of systolic function with mortality and to assess its interplay with volume removal. A total of 558 (373 male/185 female) HD patients with a median age of 66years were included in this analysis. They underwent 24-hour ambulatory blood pressure monitoring, including wave intensity analysis [i.e. S:D ratio (SDR)]. All-cause and CV mortality served as endpoints and multivariate proportional hazards models were used for risk prediction. Intradialytic changes were analysed in tertiles according to ultrafiltration volume. During a follow-up of 37.8months, 193 patients died (92 due to CV reasons). The SDR was significantly associated with all-cause {univariate hazard ratio [HR] 1.36 [95% confidence interval (CI) 1.20-1.54], P<.001} and CV [univariate HR 1.41 (95% CI 1.20-1.67), P<.001] mortality. The associations remained significant in multivariate analysis accounting for possible confounders. Changes in the SDR from pre-/early- to post-dialytic averages were significantly different for the three ultrafiltration volume groups. This study provides well-powered evidence for the independent association of a novel index of systolic function with mortality. Furthermore, it revealed a significant association between intradialytic changes of the measure and intradialytic volume removal.

Sleep and liver function biomarkers in relation to risk of incident liver cancer: a nationwide prospective cohort study

BackgroundTo assess the largely undetermined separate and joint effects of sleep and liver function biomarkers on liver cancer.MethodsData of 356,894 participants without cancer at baseline in the UK Biobank were analyzed. Sleep score was evaluated using five sleep traits (sleep duration, chronotype, insomnia, snoring, and excessive daytime sleepiness) and dichotomized into healthy or unhealthy sleep. Circulating liver function biomarkers were measured. Cox proportional hazard model was performed to investigate the independent and joint associations of sleep and liver function biomarkers with liver cancer incidence.ResultsAfter a median follow-up time of 13.1 years, 394 cases of incident liver cancer were documented. The multivariable-adjusted hazard ratio (HR) for liver cancer was 1.46 (95% confidence interval: 1.15–1.85) associated with unhealthy sleep (vs. healthy sleep), and was 1.17 (1.15–1.20), 1.20 (1.18–1.22), 1.69 (1.47–1.93), 1.06 (1.06–1.07), 1.08 (1.07–1.09), 1.81 (1.37–2.39), or 0.29 (0.18–0.46) associated with each 10-unit increase in alanine transaminase (ALT), aspartate transaminase (AST), total bilirubin (TBIL), gamma-glutamyl transferase (GGT), alkaline phosphatase (ALP), total protein (TP), or albumin (ALB), respectively. Individuals with unhealthy sleep and high (≥ median) ALT, AST, TBIL, GGT, ALP, or TP or low (< median) ALB level had the highest HR of 3.65 (2.43–5.48), 4.03 (2.69–6.03), 1.97 (1.40–2.77), 4.69 (2.98–7.37), 2.51 (1.75–3.59), 2.09 (1.51–2.89), or 2.22 (1.55–3.17) for liver cancer, respectively. Significant additive interaction of unhealthy sleep with high TP level on liver cancer was observed with relative excess risk due to an interaction of 0.80 (0.19–1.41).ConclusionsUnhealthy sleep was associated with an increased risk of liver cancer, especially in participants with lower ALB levels or higher levels of ALT, AST, TBIL, GGT, ALP, or particularly TP.

Association of dead space fraction to mortality in patients with COVID-19-related ARDS: A historical cohort observational study

ObjectiveTo assess the correlation of dead space fraction (VD/VT) measured through time capnography, corrected minute volume (CMV) and ventilation ratio (VR) with clinical outcomes in COVID-19 patients requiring invasive mechanical ventilation. DesignObservational study of a historical cohort. SettingUniversity hospital in Medellin, Colombia. ParticipantsPatients aged 15 and above with a confirmed COVID-19 diagnosis admitted to the ICU and requiring mechanical ventilation. InterventionsMeasurement of VD/VT, CMV, and VR in COVID-19 patients. Main variables of interestVD/VT, CMV, VR, demographic data, oxygenation indices and ventilatory parameters. ResultsDuring the study period, 1047 COVID-19 patients on mechanical ventilation were analyzed, of whom 446 (42%) died. Deceased patients exhibited a higher prevalence of advanced age and obesity, elevated Charlson index, higher APACHE II and SOFA scores, as well as an increase in VD/VT ratio (0.27 in survivors and 0.31 in deceased) and minute ventilation volume on the first day of mechanical ventilation. The multivariate analysis revealed independent associations to in-hospital mortality, higher VD/VT (HR 1.24; 95%CI 1.003–1.525; p = 0.046), age (HR 1.024; 95%CI 1.014–1.034; p < 0.001), and SOFA score at onset (HR: 1.036; 95%CI: 1.001–1.07; p = 0.017). ConclusionsVD/VT demonstrated an association with mortality in COVID-19 patients with ARDS on mechanical ventilation. These findings suggest that VD/VT measurement may serve as a severity marker for the disease.

Body mass index and adiposity influence responses to immune checkpoint inhibition in endometrial cancer.

Obesity is the foremost risk factor in the development of endometrial cancer (EC). However, the impact of obesity on the response to immune checkpoint inhibitors (ICI) in EC remains poorly understood. This retrospective study investigates the association between body mass index (BMI), body fat distribution, and clinical and molecular characteristics of EC patients treated with ICI. We analyzed progression-free survival (PFS) and overall survival (OS) in EC patients treated with ICI, categorized by BMI, fat mass distribution, and molecular subtypes. Incidence of immune-related adverse events (irAE) after ICI was also assessed based on BMI status. 524 EC patients were included in the study. Overweight and obese patients exhibited a significantly prolonged PFS and OS compared to normal BMI patients after treatment with ICI. Multivariable Cox regression analysis confirmed the independent association of overweight and obesity with improved PFS and OS. Elevated visceral adipose tissue (VAT) was identified as a strong independent predictor for improved PFS to ICI. Associations between obesity and OS/PFS were particularly significant in the copy number-high/TP53abnormal (CN-H/TP53abn) EC molecular subtype. Finally, obese patients demonstrated a higher irAE rate compared to normal BMI individuals. Obesity is associated with improved outcomes to ICI in EC patients and a higher rate of irAEs. This association is more pronounced in the CN-H/TP53abn EC molecular subtype. NIH/NCI Cancer Center Support Grant P30CA008748 (MSK). K08CA266740 and MSK Gerstner Physician Scholars Program (J.C.O). RUCCTS Grant #UL1 TR001866 (N.G-B and C.S.J). Cycle for survival and Breast Cancer Research Foundation grants (B.W).

Readmission after discharge from a medium secure service between 1999 and 2017: A retrospective cohort study.

Previous research into outcomes after treatment in medium secure psychiatric hospitals has mostly relied on pre-millennium data. To examine patient and inpatient service-related factors associated with readmission within 2 years following discharge to the community or open conditions from conditions of medium security. A retrospective cohort study of 137 patients discharged either to the community or to open conditions from one 64-bed South Wales Regional Medium Secure Hospital Unit between July 1999 and November 2017 was completed using data from healthcare records to document demographics, diagnosis and nature of index offences together with researcher-completed ratings of inpatient progress using the Dangerousness Understanding Recovery and Urgency Manual (DUNDRUM) Programme Completion and DUNDRUM Recovery scales. Binary logistic regression analyses were used to identify independent associations between inpatient progress according to these measures and readmission. Forty-three patients (31%) were readmitted within 2years of discharge and 23 (17%) in breach of legal conditions on discharge. Most readmitted patients (n=29, 67%) returned directly to medium secure care. There were significant binary level associations between readmission and severity of the index offences (lower), number of adverse childhood experiences (higher), history of drug misuse (more likely) and number of previous psychiatric admissions (higher). Binary logistic regression confirmed that these relationships were not independent. No inpatient service-related variables, according to DUNDRUM scale scores, showed an independent association with readmission within 2years post-discharge. The proportion of medium security hospital patients who were readmitted within 2years of discharge aligns with estimates found in earlier national research using the same follow-up period. Since levels of inpatient progress bore little if any relationship to longer term outcomes, our findings highlight the need for investigating factors in the discharge environment that are linked to readmission. It is possible that readmission may indicate effective monitoring and responsive care to the changing needs of patients, but a better understanding of this is essential.

The ratio of alanine aminotransferase to high-density lipoprotein cholesterol is positively correlated with the insulin resistance in American adults: a population-based cohort study.

Previous studies have demonstrated a correlation between the ratio of alanine aminotransferase to high-density lipoprotein cholesterol (ALT/HDL-C) in the serum and the risk of diabetes. However, no existing study has investigated the association between insulin resistance (IR) and ALT/HDL-C. Therefore, this study aims to explore the association between ALT/HDL-C and IR in American adults. A total of 7,599 adults selected from the National Health and Nutrition Examination Survey (NHANES) in 2013 to 2020 were studied. IR was assessed based on the homeostatic model assessment of insulin resistance (HOMA-IR). And the association between IR and ALT/HDL-C was assessed through multiple logistic regression, generalized smooth curve fitting and subgroup analyses. Multiple logistic regression analysis indicated a significant correlation between IR and ALT/HDL-C, with odds ratios (OR) of 1.04 (95% CI = 1.02-1.05) in males and 1.04 (95% CI = 1.02-1.07) in females. A non-linear association and saturation effect between ALT/HDL-C and IR risk were identified, with an inverted L shaped curve and an inflection point at 33.62. The area under the ROC curve (AUC) of ALT/HDL-C was significantly larger (AUC = 0.725 for males and 0.696 for females, all p < 0.01) compared with the use of ALT, HDL-C, AST and AST/ALT. Subgroup analysis showed a significantly higher independent association in obese individuals and individuals aged ≥50 years (All P interaction <0.05). Elevated ALT/HDL-C demonstrates a significant correlation with IR, which can be used as a potential indicator of IR in American adults.

Ultrathin Bronchoscopy Without Virtual Navigation for Diagnosis of Peripheral Lung Lesions.

The increasing incidence of encountering lung nodules necessitates an ongoing search for improved diagnostic procedures. Various bronchoscopic technologies have been introduced or are in development, but further studies are needed to define a method that fits best in clinical practice and health care systems. How do basic bronchoscopic tools including a combination of thin (outer diameter 4.2 mm) and ultrathin bronchoscopes (outer diameter 3.0 mm), radial endobronchial ultrasound (rEBUS) and fluoroscopy perform in peripheral pulmonary lesion diagnosis? This is a retrospective review of the performance of peripheral bronchoscopy using thin and ultrathin bronchoscopy with rEBUS and 2D fluoroscopy without a navigational system for evaluating peripheral lung lesions in a single academic medical center from 11/2015 to 1/2021. We used a strict definition for diagnostic yield and assessed the impact of different variables on diagnostic yield, specifically after employment of the ultrathin bronchoscope. Logistic regression models were employed to assess the independent associations of the most impactful variables. A total of 322 patients were included in this study. The median of the long axis diameter was 2.2 cm and the median distance of the center of the lesion from the visceral pleural surface was 1.9 cm. Overall diagnostic yield was 81.3% after employment of the ultrathin bronchoscope, with more detection of concentric rEBUS views (93% vs. 78%, p < 0.001). Sensitivity for detecting malignancy also increased from 60.5% to 74.7% (p = 0.033) after incorporating the ultrathin scope into practice, while bronchus sign and peripheral location of the lesion were not found to affect diagnostic yield. Concentric rEBUS view, solid appearance, upper/middle lobe location and larger size of the nodules were found to be independent predictors of successful achievement of diagnosis at bronchoscopy. This study demonstrates a high diagnostic yield of biopsy of lung lesions achieved by utilization of thin and ultrathin bronchoscopes. Direct visualization of small peripheral airways with simultaneous rEBUS confirmation increased localization rate of small lesions in a conventional bronchoscopy setting without virtual navigational planning.

Association of Cognitive Reserve and Preoperative Cognitive Function in Patients with Adult Moyamoya Disease: A Preliminary Study.

Many patients with moyamoya disease (MMD) exhibit cognitive decline; however, the link between cognitive reserve (CR) and cognitive function in those who have not undergone revascularization remains unexplored. We aimed to evaluate preoperative cognitive impairment in such patients and to explore the relationship between CR, measured using the Cognitive Reserve Index questionnaire (CRIq), and cognitive abilities across different domains, determined using neuropsychological tests. Demographic, clinical, CRIq, and neuropsychological assessment data were gathered from patients with MMD who underwent preoperative cognitive functional assessments at our center during 2021-2023. These patients were categorized according to their Montreal Cognitive Assessment score. Multivariable linear regression was performed to analyze the association between CRIq score and cognitive performance, both globally and in specific domains. In the MMD cohort of 53 patients, 49% (n = 26) of the patients exhibited a decrease in overall cognitive performance. Individuals with cognitive dysfunction had significantly lower composite CRIq scores than those with intact cognition. Although no association between overall cognitive ability and CR was observed, independent associations emerged between CR and specific cognitive functions - language (β = 0.56, p = 0.002), verbal memory (β = 0.45, p = 0.001), and executive function (β = 0.35, p = 0.03). This preliminary study revealed that expressive language, verbal memory, and executive function are linked to CR in presurgical patients with MMD, highlighting the role of CR in predicting cognitive outcomes. Further research is warranted to elucidate the combined effects of CR and other risk factors on the cognitive function of patients with MMD.

Association between triglyceride-glucose index and chronic kidney disease: results from NHANES 1999–2020

Abstract Aims Examining the connection between the triglyceride-glucose (TyG) index and chronic kidney disease (CKD) was the aim of this investigation. Methods Data from the National Health and Nutrition Examination Survey (NHANES) covering the years 1999–2020 were analyzed in this study. The TyG index was calculated as Ln (triglycerides (mg/dl) * fasting glucose (mg/dl)/2). The two criteria used to diagnose CKD were low estimated glomerular filtration rate (eGFR) (eGFR &lt; 60 mL/min/1.73m2) or albuminuria (urine albumin-to-creatinine ratio (ACR) ≥ 30 mg/g). To look into the independent associations between TyG index levels with CKD, albuminuria, and low-eGFR, weighted multivariable logistic regression and generalized additive models were employed. To assess and contrast the diagnostic ability, receiver operating characteristic (ROC) curves were employed. Results Out of 18,078 total participants recruited, 48.54% were male. 8.48 + 0.68 was the mean value of the TyG index. CKD, albuminuria, and low-eGFR were common, with respective prevalences of 17.06%, 11.26%, and 8.03%, respectively. The TyG index and CKD were observed to positively correlate (OR = 4.03; 95% CI 1.81, 8.96). In US adults between the ages of 41 and 60, a J-shaped connection was found between the two. Furthermore, a higher TyG index is associated with a higher prevalence of albuminuria (OR = 6.11; 95% CI 2.64, 14.14). Subgroup analyses and interaction tests revealed that different stratifications did not significantly affect the relationship between TyG index and CKD, albuminuria, and low-eGFR. Comparing the TyG index to other indicators [lipid accumulation product (LAP), Visceral adiposity index (VAI), and the triglyceride glucose–body mass index (TyG-BMI)], it may be more accurate and discriminative in predicting CKD and albuminuria. Conclusion When predicting CKD and albuminuria, the TyG index may be a more useful marker when compared to other markers (LAP, VAI, and TyG-BMI index). In addition, in American adults aged 41–60, the TyG index shows a J-shaped relationship with CKD. As a result, when assessing the kidney health of US adults, we must pay close attention to the significance of the TyG index.

Association between preoperative phase angle and all-cause mortality after cardiovascular surgery: A retrospective cohort study.

The importance of preoperative physical function assessment for post-operative intervention has been reported in older patients undergoing cardiovascular surgery. Phase angle (PhA), measured using bioelectrical impedance analysis, is an indicator of cellular health and integrity and is reported as a prognostic factor in several chronic diseases; however, its association with the long-term prognosis of cardiovascular surgery remains unclear. This study aimed to investigate the prognostic value of PhA for long-term mortality in patients undergoing cardiovascular surgery. This retrospective cohort study included consecutive patients who underwent elective cardiovascular surgery between October 2016 and March 2021 at Nagoya Heart Center, Japan. PhA was assessed using bioelectrical impedance analysis before surgery, and physical function measures (gait speed, grip strength and short physical performance battery [SPPB]) were measured synchronously. The association between PhA and all-cause mortality after discharge was assessed using Kaplan-Meier and multivariate Cox regression analyses. The incremental prognostic value of PhA was compared with other physical function measures using net reclassification improvement (NRI) and integrated discrimination improvement (IDI). A total of 858 patients were included in the present analysis (mean age=68.4±11.9years, 67.6% male). PhA positively correlated with body mass index (ρ=0.38, P<0.001), skeletal muscle mass index (ρ=0.58, P<0.001), usual gait speed (ρ=0.44, P<0.001), grip strength (ρ=0.73, P<0.001) and SPPB (ρ=0.51, P<0.001). The mean follow-up period, within which 44 (4.7%) died, was 908.9±499.9days for the entire cohort. Kaplan-Meier survival curves based on the PhA tertiles showed that higher PhA was associated with better survival (log-rank test, P<0.001). The Cox regression analysis showed the independent association of PhA with mortality risk (hazard ratio: 0.91 per 0.1° increment; 95% confidence interval [CI]: 0.87-0.95; P<0.001). The NRI and IDI showed significant improvements in predicting mortality after adding PhA to the clinical model consisting of age, sex and cardiac and renal function (NRI: 0.426, 95% CI: 0.124-0.729, P=0.006; IDI: 0.037, 95% CI: 0.012-0.062, P=0.003). The predictive model consisting of the clinical model and PhA was superior to the model consisting of the clinical model and each of the other physical function indicators (P<0.05). PhA correlated with physical function and independently predicted long-term mortality after cardiovascular surgery. The additive prognostic value of PhA compared with the other physical function measures suggests the clinical usefulness of preoperative PhA for risk stratification in planning post-operative treatment and rehabilitation.