Abnormal Index Research Articles

Gender differences in associations between obesity and hypertension, diabetes, dyslipidemia: evidence from electronic health records of 3.5 million Chinese senior population

BackgroundObesity has been arousing a critical public health issue, and posting threats to senior population. We aimed to explore gender differences in associations between general/central obesity (body mass index/waist circumference) and hypertension, diabetes, dyslipidemia based on electronic health records of 3.5 million Chinese senior population over 65 years.Methods3571189 electronic health records of Chinese senior population were collected from platform of Zhejiang provincial Basic Public Health Services Project. Sociodemographic characteristics, behavioral lifestyle, physical data, and biochemical indices were included in the research. Multivariate logistic regression models and restricted cubic spline models were used to explore associations between obesity and diseases.Results7.7% (5.3% for male, 9.7% for female) senior population were having general obesity, and 31.8% (25.2% for male, 37.4% for female) of them had central obesity. 48.0% (46.0% for male, 49.7% for female), 14.0% (12.3% for male, 15.5% for female), and 58.9% (51.6% for male, 65.2% for female) senior population were having hypertension, diabetes, and dyslipidemia, respectively. 37.9% (29.5% for male, 45.1% for female) and 33.7% (28.1% for male, 38.5% for female) senior population were having abnormal TC and TG, respectively. General obesity and central obesity strongly and negatively associated with hypertension [OR = 2.61 (95%CI: 2.58–2.63), and 2.20 (95%CI: 2.18–2.21)], diabetes [OR = 1.33 (95%CI: 1.31–1.35), and 1.56 (95%CI: 1.54–1.57)], and dyslipidemia [OR = 1.66 (95%CI: 1.64–1.68), and 1.84 (95%CI: 1.83–1.85)] based on existing obesity standards. Male population with BMI higher than 28.7 kg/m2, 30.1 kg/m2, 22.7 kg/m2, and with WC higher than 99.0 cm, 95.9 cm, 82.1 cm, while female population with BMI higher than 26.9 kg/m2, 23.3 kg/m2, 18.1 kg/m2, and with WC higher than 92.1 cm, 83.1 cm, 65.7 cm, the ORs were over 1.0 for having hypertension, diabetes, and dyslipidemia, respectively.ConclusionsSenior population were more likely to have central obesity over general obesity, and nearly half of them were having hypertension and dyslipidemia. Obesity negatively and strongly associated with chronic diseases in senior population, yet general obesity exerted more impact on hypertension, whereas central obesity exerted more impact on diabetes and dyslipidemia. Female population with obesity were in higher risk than male having hypertension, diabetes, and dyslipidemia. We recommended senior population control BMI lower than 28.7 kg/m2 and 23.3 kg/m2, as well as WC lower than 95.9 cm and 83.1 cm for male and female, respectively. Optimal BMI and WC in senior population may be around the overweight or mild obesity range. There were risks for having dyslipidemia or abnormal lipid-related indices even in senior population without obesity. TC and TG were major indicators of discovering disease and preventing senior population from dyslipidemia.

Association between abnormal systemic coagulation inflammation index and recurrence of deep venous thrombosis as well as quality of life: A retrospective study.

Deep vein thrombosis (DVT) of the lower limb is a significant clinical challenge with the potential for recurrence, which can lead to increased morbidity and reduced quality of life. A retrospective case-control study was conducted involving 367 patients diagnosed with lower limb DVT from June 2020 to June 2023. Patients were categorized into a recurrence group (n = 121) and a non-recurrence group (n = 246) based on DVT occurrence. Data were systematically collected from medical records, including demographic information, thrombus characteristics, patient compliance, coagulation parameters, inflammatory markers, and quality of life assessments using the CIVIQ-20 and SF-36 scales. The recurrence group had significantly higher mean age, history of orthopedic diseases, and pregnancy, reduced compliance with compression therapy and anticoagulation, and elevated inflammatory markers including IL-6, IL-8, and TNF-α. Prolonged coagulation times (PT, APTT, TT) were associated with a lower risk of recurrence. The SCI index was significantly lower in the recurrence group. Multivariate logistic regression identified age, IL-6, IL-8, PT, APTT, TT, and SCI index as significant predictors of recurrence. Quality of life scores were lower in the recurrence group, indicating a higher impact on mental and overall health. ROC analyses demonstrated strong predictive capacity (AUC = 0.905) of SCI index. The study underscores the multifactorial nature of DVT recurrence, highlighting the role of age, systemic inflammation, coagulation times, and compliance with therapeutic interventions. The SCI index emerges as a compelling prognostic marker for assessing the risk of DVT recurrence. These findings emphasize the need for comprehensive management strategies incorporating these parameters to prevent recurrence and improve patients' quality of life.

Elevated risk of possible sarcopenia and weak muscle strength with higher dietary inflammatory index in Iranian breast cancer survivors: a cross-sectional study

BackgroundIncreased levels of inflammation in cancer patients and survivors can make them more prone to muscle wasting and sarcopenia. Diet can be an appropriate treatment for alleviating patient complications. Therefore, this study was performed to determine the association between sarcopenia and its components with the dietary inflammatory index (DII) among breast cancer survivors.MethodsA total of 223 female breast cancer survivors were included in this research at the Cancer Prevention Research Center of Seyyed Al-Shohada Hospital and the Iranian Cancer Control Charity Institute (MACSA). Forty-three items of dietary inflammatory index (DII) were extracted from the Food Frequency Questionnaire. Sarcopenia detection was performed according to the Asian criteria. The linear and binary logistic regression was used to assess the association between sarcopenia and its components with DII.ResultsParticipants in the highest DII quartile had significantly elevated risk of impaired hand grip strength and calf circumference in both crude and adjusted models. Moreover, individuals consuming a more pro-inflammatory diet displayed a greater risk of abnormal appendicular skeletal muscle index in the crude model. After controlling for potential confounders, participants in the top quartile of DII had a 2.992-fold greater risk of possible sarcopenia than those in the bottom quartile (P value = 0.035). In addition, a decreasing linear trend was observed between higher DII score and 0.059 and 0.349- units lower in appendicular skeletal muscle mass index and hand grip strength variables in the crude Model (P-value < 0.05).ConclusionDiets with more pro-inflammatory features might be associated with increased risk of possible sarcopenia, as well as its components especially muscle mass and strength in women recovering from breast cancer.

Effect of elexacaftor-tezacaftor-ivacaftor on liver transient elastography, fibrosis indices and blood tests in children with cystic fibrosis.

Elexacaftor-tezacaftor-ivacaftor (ETI) has significantly improved the clinical course of people with cystic fibrosis (pwCF) and eligible CFTR variants. In this study, we prospectively evaluated liver elastography, liver fibrosis indices and liver tests in children with CF aged 6-12 years started on ETI therapy. Body mass index, sweat test, percent predicted forced expiratory volume in one second, serum markers of liver injury or portal hypertension, liver fibrosis indices, controlled attenuation parameter and liver stiffness were assessed before starting ETI and three and twelve months post-ETI, according to new international guidelines. 27 children with CF were enrolled, 14 with liver involvement and 13 without liver involvement at baseline. A significant improvement in sweat chloride after ETI was observed in all subjects. In those with liver involvement, liver stiffness significantly decreased at 12 months of ETI, with all individuals achieving normalization or near-normalization of liver stiffness. The majority of individuals with abnormal AST, ALT, GGT, or liver fibrosis indices at baseline experienced normalization by 12 months of ETI (AST: 67%, ALT: 100%, GGT: 50%, APRI: 100%, GPR: 100%). In the no liver involvement group, the only significant change in liver health metrics at 12 months was a significant reduction in platelets (P<0.05) that remained within the normal range. ETI is associated with improvement in liver stiffness, liver function tests and fibrosis indices in pwCF and liver involvement. ETI may reduce the development of advanced CF liver disease, but longer observations with larger cohorts are needed.

Prevalence and risk factors of the most common multimorbidity among Canadian adults.

The number of persons living with multimorbidity-defined as the co-occurrence of at least two chronic conditions in the same individual-is growing globally, especially in developed countries. Traditionally, this increase has been attributed to a growing aging population, sedentary lifestyle, obesity, low socioeconomic status, and individual genetic susceptibility. To investigate the prevalence and associated risk factors of the most common multimorbidity (MCM) among Canadian middle-aged and older adults. Relevant data on all 30,097 middle-aged and older Canadian adults (aged 45 to 85 years) from the Canadian Longitudinal Study on Aging were used for this study. To identify the specific sociodemographic risk factors associated with the MCM, we used survey-specific logistic regression. Overall, co-occurrence of osteoarthritis and hypertension was identified as the MCM among Canadian adults aged 45+ with an estimated prevalence of 16.5%. The results from multivariate analysis showed that seven factors were significantly associated with increased odds of the MCM, which included increasing age, being retired from work (retired vs not retired), poorer rating of perceived health, (very good, good, poor vs excellent), increasing problems with sleep quality (satisfied, dissatisfied vs neutral), and abnormal body-mass index (underweight, overweight, obese vs normal). Also, residents in other urban centres had significantly lower odds than those in urban core. Persons living in Atlantic Canada, Ontario and Quebec were at increased odds of having the MCM compared to those in British Columbia. The odds of the MCM associated with increasing age was significantly higher among Females (OR = 1.12, 95% CI = 1.11-1.13) than Males (OR = 1.08, 95% CI = 1.07-1.10). Multimorbidity is a common feature among Canadian adults. The identification of the most prevalent patterns and associated risk factors in this study provides fresh insights into the etiology, progression, and possible prevention of the MCM among Canadian adults.

Ureaplasma urealyticum infection following organ transplantation: a case report and narrative review

Objective One case of Ureaplasma urealyticum (UU) infection after kidney transplantation was reported, and relevant literature was collected to provide a scientific reference basis for clinical diagnosis and treatment. Methods A case of UU infection after renal transplantation in our hospital was analyzed retrospectively. PubMed, Embase and Cochrane databases were searched for case reports of UU infection after organ transplantation before 30 June 2024. The clinical and laboratory characteristics, treatment and prognosis of UU infection were summarized and analyzed. Results A 65-year-old man underwent renal transplantation on 26 January 2022 due to chronic renal disease (grade 2) caused by focal sclerosing glomerulonephritis. Hyperammonaemia and coma occurred after the operation, and the patient died. A total of 38 case reports or series of cases were included in this study, involving 44 patients. The case reports included 22 cases of kidney transplantation, 11 cases of lung transplantation, 4 cases of heart transplantation,1 case of liver transplantation and 6 cases of multiple organ transplantation. Ureaplasma urealyticum infection occurred in 74.47% of cases within 1 month after transplantation, and the main symptoms after the infection were mental. After the onset of the disease, the most abnormal examination index was the increase of blood ammonia, followed by the increase of white blood cells. Therapeutic drugs included tetracyclines (doxycycline or minocycline), quinolones and azithromycin. The clinical symptoms could be significantly improved after 24 h of taking the fastest-acting medication. The highest mortality rate was in patients infected with Ureaplasma after lung transplantation. Conclusion Early identification of UU and timely and correct drug treatment are essential to saving the lives of patients.

Development of a quantitative assessment for abnormal flexor synergy index in patients with stroke: a validity and responsiveness study

BackgroundArm-lifting movements (shoulder flexion) are essential for upper extremity rehabilitation after a stroke. Abnormal flexor synergy (elbow flexion) is frequently observed during shoulder flexion, impeding functional improvement. However, no quantitative method exists for assessing abnormal flexor synergy. This study investigated the validity and responsiveness of a newly developed index to quantitatively evaluate abnormal flexor synergy.MethodsParticipants included 103 patients (mean age: 58.0 ± 10.1 years; 64 men, 39 women) with stroke. Using three-dimensional coordinate data during shoulder flexion obtained from a depth sensor camera, we calculated the abnormal flexor synergy based on our developed index. The abnormal flexor synergy index decreases with increasing flexion of the elbow joint during shoulder flexion (the maximum value is 100% without abnormal flexor synergy). The validity of the abnormal flexor synergy index was assessed by analyzing the correlation between the index and both the Fugl–Meyer Assessment of the Upper Extremity (FMA-UE) four-category scores and the Modified Ashworth Scale (MAS) scores for elbow, wrist, and finger flexors, using Pearson’s and Spearman’s correlation coefficients. Responsiveness was studied in 17 inpatients (mean age: 59.5 ± 8.1 years; 7 men, 10 women) who underwent proximal upper extremity intervention for approximately 3 weeks, evaluating change from admission to discharge using the standardized response mean (SRM).ResultsSignificant correlations were observed between the abnormal flexor synergy index and FMA-UE scores: A (r = 0.625, p < 0.001), B (r = 0.433, p < 0.001), C (r = 0.418, p < 0.001), and D (r = 0.411, p < 0.001), as well as MAS scores for elbow flexors (r = -0.283, p = 0.004) and proximal interphalangeal flexors (r = -0.201, p = 0.042). The highest responsiveness was observed in the FMA-UE A score (SRM = 0.81), followed by the abnormal flexor synergy index (SRM = 0.79).ConclusionsThe newly developed index for assessing abnormal flexor synergy demonstrated superior validity and high responsiveness. These results suggest the potential for using this index to evaluate upper extremity function in patients with stroke.

Autoimmune brainstem encephalitis: Clinical associations, outcomes, and proposed diagnostic criteria.

We describe neurologic phenotype, clinical associations, and outcomes in autoimmune brainstem encephalitis. Medical records of neural-IgG positive autoimmune brainstem encephalitis patients diagnosed at Mayo Clinic (January 1, 2006-December 31, 2022) were reviewed. Ninety-eight patients (57 male) were included. Median age of symptom onset was 51 years (range, 8 months-85 years). Frequent presenting features were ≥1: diplopia (80%), ataxia (78%), dysarthria (68%), vestibulocochlear symptoms (67%), dysphagia (61%), nausea/vomiting (42%), and facial weakness (32%). Altered mental status (11%) was uncommon. Neural antibodies detected were as follows: KLHL-11 (26 patients), GAD65 (high titer, 12), ANNA-1 (anti-Hu, 8), ANNA-2 (anti-Ri, 8), Ma2 (7), IgLON-5 (6), AQP4 (6), MOG (4), glycine receptor (4), GQ1B (4), PCA-1 (anti-Yo, 4), DPPX (2), neurochondrin (2), neurofilament (2), NMDA-R (2), AGNA-1 (SOX-1, 1), ANNA-3 (DACH1, 1), amphiphysin (1), CRMP-5 (1), ITPR-1 (1), PCA-Tr (DNER, 1), and PDE10A (1). Cancer was identified in 55 patients: germ cell (23 patients; 3 extra-testicular), ductal breast adenocarcinoma (8), small cell carcinoma (6, lung 4), adenocarcinomas (6), neuroendocrine carcinoma (3), hematologic (2), squamous cell (2), and other (7). Median modified Ranking score (mRS) at last follow-up was 3 (range, 0-6). Factors associated with poor outcome included abnormal brain MRI, bulbar symptoms, and elevated CSF IgG index. Kaplan-Meier analysis revealed faster progression to wheelchair in patients who were immunotherapy refractory and with elevated CSF IgG index. Diagnostic criteria for autoimmune brainstem encephalitis (definite and probable) are proposed. Autoimmune brainstem encephalitis is a distinct clinical subphenotype of autoimmune encephalitis. Abnormal brain MRI, bulbar symptoms, and elevated CSF-IgG index associate with poor outcome.

Evaluation of morphological and cytotoxic effects of minoxidil on Phaseolus vulgaris L. as a plant model.

The increasing presence of drugs in the environment has triggered a pollution crisis on a global scale, generating concern about their ecotoxicological effects on ecosystems. In this context, minoxidil, a vasodilator drug widely used in the treatment of androgenic alopecia, has been scarcely investigated in plant systems. Therefore, this study evaluated the morphological and cytotoxic effects of minoxidil on Phaseolus vulgaris L as a bioindicator. P. vulgaris seeds were exposed to different concentrations of minoxidil (0.0, 0.25, 0.5, 1, 1.25, 2.5 and 5mg/L) and parameters such as germination, root growth, mitotic index and frequency of chromosomal abnormalities were assessed. The results showed a significant inhibition of germination (75-76%) and root growth (52.6-55.3%) at high concentrations of minoxidil (2.55mg/L-5mg/L). In addition, a decrease in the mitotic index (8.2) and an increase in the frequency of chromosomal abnormalities (10.2) were observed, suggesting a cytotoxic effect. These findings show that minoxidil, even at low concentrations, can have adverse effects on the morphology and cell division of P. vulgaris. This study demonstrates the potential of plants as tools to evaluate the phytotoxicity and cytotoxicity of drugs and highlights the need to implement measures to reduce the contamination of these drugs in the environment.

Atypical Presentation and Delayed Diagnosis of Herlyn-Werner-Wunderlich Syndrome: A Case Report and Literature Review

Herlyn-Werner-Wunderlich syndrome (HWWS) is a rare and complex Mullerian duct abnormality that is diagnostically challenging. It is also known as OHVIRA syndrome. The triad of uterine didelphys, obstructed hemivagina and ipsilateral renal anomaly characterises the syndrome. A 25-year-old lady was referred with prolonged foul-smelling vaginal discharge. Her periods were regular with normal flow. A vaginal examination revealed a normal cervix and fullness of left adnexa. A pelvic ultrasound showed a left adnexal mass. Computed tomography imaging of the abdomen and pelvis revealed two uterine cavities with a large cystic lesion at the level of the cervix. This lesion was communicating with the uterine cavity, raising the possibility of obstruction. Only the right kidney was present. A diagnosis of HWWS was made. The patient underwent diagnostic laparoscopy, examination under anaesthesia and excision of the vaginal septum. At follow-up, she remained well at 6 weeks and 3 months. The normal mesonephric duct plays an important role in the formation of the uterus, vagina and the upper urinary tract. HWWS occurs when one of the mesonephric ducts is absent or injured during embryogenesis. Women with HWWS usually present after menarche with varied symptoms, causing delays in diagnosis and treatment. Therefore, having a high suspicion index and awareness of Mullerian duct abnormalities is crucial. The gold standard for the evaluation of HWWS is magnetic resonance imaging. Surgical excision of the septum is the advocated treatment of choice. Prompt intervention lowers complications that impair fertility.

Development of a Preliminary Screening Tool for Predicting Polycystic Ovarian Syndrome using Machine Learning and Deep Learning Models with Non Invasive Qualitative Features: A Case-control Study

Introduction: Polycystic Ovarian Syndrome (PCOS) is a prevalent endocrine disorder affecting women of reproductive age, characterised by irregular menstrual cycles, hyperandrogenism and polycystic ovaries. Despite its high prevalence, the diagnosis of PCOS remains challenging due to the variability in symptom presentation. Traditional diagnostic methods involve clinical evaluation, biochemical assays and ultrasound imaging. Machine Learning (ML) and Deep Learning (DL) models offer promising avenues for predicting probable cases of PCOS using non invasive qualitative features. Aim: To develop and compare the performance of Random Forest (RF) and Feedforward Neural Network (FFNN) models in predicting PCOS using abundant non invasive qualitative features. Materials and Methods: A retrospective case-control study was conducted with 100 cases and 100 controls, selected based on ultrasound-confirmed PCOS diagnosis in the Obstetrics and Gynaecology, Gayatri Vidya Parishad Institute of Healthcare and Medical Technology (GVP IHC MT), Medical College departments from February 2024 to October 2024. Data were collected using a structured questionnaire capturing demographic and clinical variables. Feature selection was performed using the Chi-square filter method, with 10 features identified as significant. The data were split into training (80%) and testing (20%) sets and stratified 5-fold cross-validation was applied. Model performance was evaluated using accuracy, precision, recall, F1 score and Area Under Curve (AUC). Results: The RF model demonstrated high performance on the training set, with an average accuracy of 0.95, but exhibited variability on the testing set (accuracy of 0.80). The FFNN model showed consistent performance across both training (accuracy of 0.80) and testing datasets (accuracy of 0.82). The RF model identified irregular cycles and hirsutism as key predictors, while the FFNN model highlighted weight gain and abnormal Body Mass Index (BMI) as important features. The RF model required significantly less computational time compared to the FFNN model. Conclusion: The RF model is preferable for tasks requiring computational efficiency, while the FFNN model offers better generalisation. The complementary feature importance rankings suggest that integrating insights from both models could enhance the understanding of PCOS predictors. In epidemiological investigations, these models can be used as preliminary screening tools for identifying probable cases of PCOS using non invasive qualitative features, especially in areas where diagnostic facilities are not available.

Coronary microvascular function and atherosclerotic plaque burden in ischaemia and no obstructive coronary arteries: a secondary analysis of the CorMicA trial

BackgroundThe relationship between atherosclerosis and endotypes of myocardial ischaemia with no obstructive coronary artery disease (INOCA) is unclear. We investigated potential associations between cumulative atherosclerotic plaque burden quantified using the...

Correlation between gestational diabetes mellitus and postpartum cardiovascular metabolic indicators and inflammatory factors: a cohort study of Chinese population.

This study aimed to analyze the correlation between gestational diabetes mellitus and postpartum metabolic indicators and inflammatory factors, and explore the role of inflammatory factors, so as to provide evidence for the early prevention of postpartum CVD risk in gestational diabetes mellitus. This prospective study was based on the pregnant women cohort study established in Peking University International Hospital from December 2017 to March 2019. A total of 120 women were enrolled sequentially, including 60 cases of gestational diabetes mellitus (GDM group) and 60 cases of non-gestational diabetes mellitus (non-GDM group) after 4-7 years. The general information, inflammatory factors and metabolic indicators of the women were collected and analyzed. (1)The TyG and siMS levels in the GDM group were higher than those in the non-GDM group (p<0.05, respectively). The interleukin-6(IL-6) levels in the GDM group were higher than those in the non-GDM group and the difference was statistically significant (p<0.05). (2) The results of linear regression analysis showed that GDM was associated with postpartum GLU0min (β=0.94, 95%CI: 0.27-1.60, p<0.05), GLU120min (β=2.76, 95%CI: 1.57-3.94, p<0.05) and HbA1c (β=0.49, 95%CI: 0.27-1.60, p<0.05). At the same time, GDM was significantly correlated with postpartum metabolic indicators triglyceride-glucose (TyG) index (β=0.31, 95%CI: 0.01-0.61, p<0.05) and siMS score (β=0.45, 95%CI: 0.03-0.88, p<0.05).The results of linear regression analysis showed that GDM was significantly correlated with IL-6 (β=0.91, 95%CI: 0.02-1.79, p<0.05). (3) Logistic regression analysis showed that GDM was an independent risk factor for postpartum abnormal metabolism (OR=10.62, 95%CI: 1.66-68.17, p<0.05), and an independent risk factor for postpartum high low-density lipoprotein cholesterolemia (OR=3.38, 95%CI: 1.01-11.56, p<0.05). (4) The IL-6 had a mediating effect in the association between GDM and postpartum TyG and siMS, with the mediating effect sizes being 20.59% and 30.77%, respectively. This study revealed that GDM history can lead to abnormal glucose and lipid metabolism indexes in postpartum women, affect the levels of postpartum CVD-related metabolic indicators. Meanwhile, IL-6 shows a mediating role, providing important clinical evidence for the prevention and control of CVD in such high-risk populations and the improvement of cardiovascular health.

Prevalence of Menstrual Disorders Related to Body Mass Index (BMI)

Menstrual problems affect as high as 90% of adolescent females and are the main reason for gynecology visits. Menstruation is a normal physiological phenomenon for females indicating her capability for procreation. Menstrual problems are common in adolescent girls, which may affect their life and outdoor activities. Adolescent girls with abnormal body mass index (BMI) suffer even more often. This study aimed to To assess the relationship between Menstrual Cycle Disorders and Symptoms Menstrual Cycle with BMI among adolescent school in MTs Bustanul Ulum. This study was a cross-sectional study conducted among 30 adolescent school girls of MTs Bustanul Ulum. Permission was obtained from principal of the school and written informed consent was taken from the parents of the school girls before taking part in the study. MC disorders included amenorrhoea, polymenorrhea, oligomenorrhoea, hypermenorrhoea and hypomenorrhoea. MC-related symptoms included dysmenorrhoea and premenstrual syndrome (PMS). All the data were collected, entered, and analyzed in SPSS 17.0. The data were analyzed using percentages and proportions through tables. Out of 30 adolescent girls, 19 (63.3%) were having a BMI 18.5, which implies that 50% of the girls were undernourished. Only 2 (6.7%) of adolescent girls were overweight. Adolescent girls who have a BMI 18.5 experience more symptoms and problems associated with menstrual cycles. This difference was statistically significant. Menstrual problems especially dysmenorrhea are frequent among adolescent girls. BMI play a very vital role for menstrual cycle regularity. Consequently, adolescent girls have to be given healthy and balance nutrition, which leads to maintenance of their normal BMI and regulate their menstrual cycle.

Analysis of Circulating Catestatin in Early Pregnancy: A Preliminary Investigation.

Background: During pregnancy, significant cardiovascular changes occur to accommodate fetal growth, and catestatin may play a role in these changes. Evidence suggests that catestatin, a pleiotropic sympathoinhibitory peptide, is involved in multiple cardiovascular pathologies, including hypertensive disorders. The objective of this study was to compare serum catestatin levels between first-trimester pregnant women and non-pregnant women, aiming to investigate catestatin's role in blood pressure regulation during early pregnancy. Methods: This cross-sectional study included 72 first-trimester pregnant women and 57 age-matched non-pregnant controls, all without known cardiovascular or metabolic disorders. Results: Serum catestatin concentrations were significantly higher in pregnant women compared to controls (12.4 (9.9-21.2) ng/mL vs. 7.1 (4.5-10.9) ng/mL, p < 0.001). However, there was no significant difference in serum catestatin levels between those with a normal and abnormal uterine artery pulsatility index (17.8 (8.3-22.3) ng/mL vs. 12.5 (9.9-22.4) ng/mL, p = 0.962). Similarly, catestatin concentrations did not significantly differ between primiparous and multiparous women (14.0 (11.5-22.4) ng/mL vs. 10.7 (8.8-19.0) ng/mL). A positive correlation was observed between systolic blood pressure and serum catestatin levels in the control group (r = 0.335, p = 0.011) but not in pregnant women. Conclusions: Research on catestatin in pregnancy is still in its early stages, necessitating further studies to fully elucidate its roles and potential therapeutic applications.

Association between Abnormal Systemic Coagulation Inflammation Index and Recurrence of Deep Venous Thrombosis as well as Quality of Life: A Retrospective Study.

BackgroundDeep vein thrombosis (DVT) of the lower limb is a significant clinical challenge with the potential for recurrence, which can lead to increased morbidity and reduced quality of life. This study aimed to identify factors associated with the recurrence of lower limb DVT by analyzing clinical, demographic, and biological markers, including the systemic coagulation-inflammation (SCI) index. MethodsA retrospective case-control study was conducted involving 367 patients diagnosed with lower limb DVT from June 2020 to June 2023. Patients were categorized into a recurrence group (n = 121) and a non-recurrence group (n = 246) based on DVT occurrence. Data were systematically collected from medical records, including demographic information, thrombus characteristics, patient compliance, coagulation parameters, inflammatory markers, and quality of life assessments using the CIVIQ-20 and SF-36 scales. Statistical analyses included differential analysis, correlation analyses, logistic regression, and receiver operating characteristic (ROC) analyses to identify predictive factors for DVT recurrence. ResultsThe recurrence group had significantly higher mean age, history of orthopedic diseases, and pregnancy, reduced compliance with compression therapy and anticoagulation, and elevated inflammatory markers including IL-6, IL-8, and TNF-α. Prolonged coagulation times (PT, APTT, TT) were associated with a lower risk of recurrence. The SCI index was significantly lower in the recurrence group. Multivariate logistic regression identified age, IL-6, IL-8, PT, APTT, TT, and SCI index as significant predictors of recurrence. Quality of life scores were lower in the recurrence group, indicating a higher impact on mental and overall health. ROC analyses demonstrated strong predictive capacity (AUC = 0.905) of SCI index. ConclusionThe study underscores the multifactorial nature of DVT recurrence, highlighting the role of age, systemic inflammation, coagulation times, and compliance with therapeutic interventions. The SCI index emerges as a compelling prognostic marker for assessing the risk of DVT recurrence. These findings emphasize the need for comprehensive management strategies incorporating these parameters to prevent recurrence and improve patients' quality of life.

Efficacy of Uterine Artery Doppler Changes, Platelet Indices and Combination of Both in Prediction of Preeclampsia in Pregnant Women: A Prospective Observational Study

Introduction: Preeclampsia is a pregnancy-specific medical disorder characterised by an abnormal vascular response to placentation. Uterine artery Doppler ultrasound has emerged as a predictive tool in preeclampsia. Abnormal Doppler waveforms have been associated with impaired placental perfusion and an increased risk of developing preeclampsia. Preeclampsia is associated with alterations in platelet function and activation. The estimation of platelet indices is an easy and economical method for screening preeclampsia. Abnormal uterine artery Doppler findings and abnormal platelet indices are both related to the etiological pathways of preeclampsia. Aim: To compare the efficacy of uterine artery Doppler changes, platelet indices alone and their combination in predicting preeclampsia among pregnant women. Materials and Methods: This was a prospective observational study conducted Department of Obstetrics and Gynaecology, Gandhi Hospital in Secunderabad, Telangana, India, over 18 months, including 160 pregnant women aged 18-35 years with singleton pregnancies between 20-24 weeks of gestational age. Doppler ultrasound and platelet indices were measured and patients were followed-up until delivery for the development of preeclampsia. Receiver Operating Characteristic (ROC) curves were constructed and sensitivity, specificity and accuracy were determined to predict preeclampsia. Results: The mean age of the study population was 25.9±4.04 years. The sensitivity, specificity, Positive Predictive Value (PPV), Negative Predictive Value (NPV) and accuracy of platelet indices in predicting preeclampsia alone were 67.71%, 59.38%, 71.43%, 55.07% and 64.38%, respectively. The sensitivity, specificity, PPV, NPV and accuracy of the uterine artery Doppler indices in predicting preeclampsia alone were 77.08%, 68.75%, 78.72%, 66.67% and 73.75%. The combined assessment of uterine artery Doppler study and platelet indices in the prognostication of preeclampsia had a sensitivity of 85.42%, specificity of 82.81%, PPV of 88.17% and NPV of 79.10%, with improved accuracy of 84.38%. Conclusion: A combination of uterine artery Doppler ultrasound with platelet indices is easy to use, affordable, readily available in clinical settings and more effective in predicting preeclampsia than when used individually.

Association between pyrrolizidine alkaloids exposure and risk of abnormal serum indices—Insights from a descriptive cross-sectional study in Yunnan Province

The hazard of pyrrolizidine alkaloids (PAs) has been widely reported in animal studies but rarely in population-based research, especially reports about daily exposure. A single-centre descriptive cross-sectional study was conducted on 552 Lahu Autonomous County residents recruited in 2021. Blood PAs exposure biomarker (pyrrole- protein adduct, PPA) and serum biochemical indices were measured. The prevalence of abnormal serum indices and PAs exposure in this region were elucidated using descriptive analyses. 75 % of Lahu Autonomous County participants were exposed to PAs. PAs exposure risk in males was lower than in females (OR=0.357, 95 % CI: 0.222-0.574), and varied with the ethnicity of Lahu Autonomous County. PPA concentration was positively correlated with serum alanine transaminase (ALT) activity (r=0.6263, P < 0.01) and triglyceride level (r=0.2327, P < 0.01); PAs exposure was positively associated with anbormal serum ALT activity (x2=99.629, P < 0.001; OR=1.428, 95 % CI: 1.293–2.319) and hypertriglyceridemia (x2=15.376, P < 0.001; OR=1.629, 95 % CI: 1.229–2.251). These results suggest that PAs exposure might be a risk factor for serum ALT abnormality and hypertriglyceridemia in the local population. This study conducted the first epidemiological study on PAs exposure in China and established the etiological hypotheses for health issues in Lahu Autonomous County.

Expanded Fetal Growth Restriction Definition Identifies High Proportion of Umbilical Artery Doppler Anomalies.

Fetal growth restriction (FGR) increases the risk for perinatal morbidity and mortality. The Society for Maternal-Fetal Medicine expanded the definition of FGR to independently include abdominal circumference (AC) < 10th percentile for gestational age (GA), regardless of estimated fetal weight (EFW). While studies have shown increased detection of small for GA neonates with expanded definition, no studies have evaluated the likelihood of abnormal umbilical artery Dopplers (UAD) detection with expanded definition. The objective of this study was to compare the likelihood of identifying UAD abnormalities in fetuses with normal EFW and restricted AC versus those by EFW alone. Single-institution retrospective cohort study of fetal growth ultrasounds meeting criteria for FGR either by EFW < 10th percentile or AC < 10th percentile with normal EFW. Those with FGR by AC alone were compared with those with FGR by EFW. Primary outcome was prevalence of UAD abnormalities, including elevated systolic/diastolic ratio, and absent and/or reversed end diastolic velocity. Receiver operator characteristic curves were generated to compare predictive value of UAD abnormalities by FGR definition. A total of 619 scans met criteria for FGR between November 2020 and June 2021, with 441 (71%) meeting definition by EFW and 178 (29%) by AC criteria alone. Baseline characteristics were similar between groups. FGR by AC alone was identified earlier (30.4 ± 3.3 vs. 35.4 ± 3.0 weeks' gestation, p < 0.001) with higher proportion identified before 32 weeks (70 vs. 11%, p < 0.001). Proportion of abnormal UAD were similar between groups (15 vs. 15%, adjusted odds ratio: 1.12, 95% confidence interval: 0.61-2.23). Use of EFW alone would have failed to identify 29% of abnormal UAD. A combined definition of FGR had the highest detection of abnormal UAD (area under curve: 0.78 vs. AC alone 0.73 vs. EFW alone 0.69). A definition of FGR that considers both EFW and AC improves detection of abnormal UAD. · Fetuses with restricted AC are equally likely to exhibit abnormal UAD indices compared with those that meet criteria by EFW.. · Earlier GA of FGR detection and improved detection of abnormal UAD with expanded growth definition.. · Expanded definition of FGR significantly improves detection of abnormal UAD as compared with those diagnosed with EFW criteria alone.. · Expanded growth restriction definition improves Doppler identification..

Coexistence of coronary microvascular dysfunction and left ventricular hypertrophy can predict prognosis of patients with nonobstructive coronary arteries

Abstract Background Previous studies have reported that coronary microvascular dysfunction (CMD) and left ventricular hypertrophy (LVH) were associated with adverse cardiovascular events. The aim of this study was to determine the prognostic impact of coexistence of abnormal coronary flow reserve (CFR) and left ventricular mass index (LVMI). Methods and results This study included 297 patients who underwent intracoronary physiological assessment including CFR for suspected myocardial ischemia without significant stenosis in the epicardial coronary artery at our hospital from December 2019 to March 2023. Of 297 patients (female: n=89 [30%], age: 70±11 years), 93 (31%) had CMD (CFR&amp;lt;2.5) and 133 (45%) had LVH (LVMI&amp;gt;95 g/m2 for female and &amp;gt;115 g/m2 for male). We excluded patients with history of heart failure (HF). Patients were classified into 4 groups based on the cut-off values of CFR and LVMI: group 1 (no CMD nor LVH, n=109); group 2 (only LVH, n=95); group 3 (only CMD, n=55) and group 4 (both CMD and LVH, n=38). Patients of group 4 had a larger proportion of female (female 19%, 34%, 24% and 61% in group 1 to 4 respectively). There was no significant difference in left ventricular ejection fraction between patients of each groups. Clinical follow-up was performed for major adverse cardiovascular events (MACE) including cardiovascular death, myocardial infarction and hospitalization for new-onset HF. During a median follow-up of 753 days, the cumulative MACE-free survival rate at 2 year were 99.0%, 98.9%, 95.6% and 90.0% in groups 1 to 4. Group 4 showed significantly higher risk of MACE at 2 year compared with group 1 (hazard ratio [HR] 2.6; 95% confidence interval [CI] 1.3-5.3; p=0.009). Notably, Group 4 showed the highest incidence of hospitalization for new-onset HF than any other groups. Conclusion Patients with both CMD and LVH showed significantly higher risk for MACE and new onset of HF. The combined classification based on CFR and LVMI would identify the high-risk patients for MACE as well as new-onset HF.