Long-term Risk Factors Research Articles

Long‑term mortality and risk factor analysis in hypertrophic cardiomyopathy patients with implantable cardioverter‑defibrillators.

Long‑term mortality and risk factor analysis in hypertrophic cardiomyopathy patients with implantable cardioverter‑defibrillators.

Native-tissue prolapse repair: Efficacy and adverse effects of uterosacral ligaments suspension at 10-year follow up.

ObjectiveTo evaluate the 10‐year outcomes of high uterosacral ligaments suspension as a primary repair for apical prolapse and to evaluate the long‐term impact of prognostic factors.MethodsA retrospective study analyzed 10‐year follow up after repair of primary apical prolapse through high uterosacral ligament suspension. Bulging symptoms and postoperative prolapse stage II or above were considered subjective and objective recurrences, respectively. Patient Global Impression of Improvement score was used to evaluate subjective satisfaction after surgery.ResultsA total of 287 women were analyzed. Ten‐year recurrence rates were 19.1% for objective recurrence and 6.3% for subjective recurrence; surgical retreatment rate was 2.1%. Premenopausal status was related to 15‐fold increased risk of developing either objective or subjective recurrence. Conversely, anterior and posterior repair were protective factors against reoperation.ConclusionHigh uterosacral ligaments suspension is a safe and long‐lasting effective procedure for the treatment of uterovaginal prolapse even 10 years after index surgery. Premenopausal status and lack of anterior and posterior repair represented long‐term risk factors for surgical failure.

Sarcomas: long-term outcomes and risk factors for recurrence and mortality

Sarcomas: long-term outcomes and risk factors for recurrence and mortality

Activated Pancreatic Stellate Cells Promote Acinar Duct Metaplasia by Disrupting Mitochondrial Respiration and Releasing Reactive Oxygen Species

Background: Chronic Pancreatitis (CP) is a long-term risk factor for pancreatic ductal adenocarcinoma (PDAC), and both diseases share a common etiology. The activation of Pancreatic stellate cells (PaSCs) caused by inflammation of the chronic pancreas plays a pivotal role in the pathology of pancreatic fibrosis and the malignant phenotype of PDAC. However, the central role of activated PaSCs in Acinar-to-Ductal Metaplasia (ADM) remains unknown. Objective: In the present study, we investigated the link between pancreatic fibrosis and ADM and the possible underlying mechanism. Methods: A caerulein-treated mouse CP model was established, and Masson trichrome histochemical stain and Transmission Electron Microscope (TEM) were used to observe stromal fibrosis and cell ultrastructure, respectively. The expression of amylase and cytokeratin 19 (CK19), mitochondria respiration, and reactive oxygen species (ROS) were detected in vitro in the co-culture model of primary pancreatic acinar cells and PaSCs. Results: The activation of PaSCs and pancreatic fibrosis were accompanied by ADM in pancreatic parenchyma in caerulein-treated mice, which was verified by the co-cultivation experiment in vitro. Furthermore, we showed that activated PaSCs promote ADM by disrupting mitochondrial respiration and releasing ROS. The expression of inflammation-and ADM-related genes, including S100A8, S100A9, and CK19, was observed to be up-regulated in pancreatic acinar cells in the presence of activated PaSCs. The expression of S100A9 and CK19 proteins was also up-regulated in acinar cells co-cultured with activated PaSCs. Conclusion: The manipulation of mitochondrial respiration and ROS release is a promising preventive and/or therapeutic strategy for PDAC, and S100A9 is expected to be a therapeutic target to block the ADM process induced by the activation of PaSCs.

Risk Factors of Long‐Term Incisional Hernia after Open Surgery for Abdominal Aortic Aneurysm: A Bicentric Study

Risk Factors of Long‐Term Incisional Hernia after Open Surgery for Abdominal Aortic Aneurysm: A Bicentric Study

Health Status, Persistent Symptoms, and Effort Intolerance One Year After Acute COVID-19 Infection.

BackgroundThe long-term prevalence and risk factors for post-acute COVID-19 sequelae (PASC) are not well described and may have important implications for unvaccinated populations and policy makers.ObjectiveTo assess health status, persistent symptoms, and effort tolerance approximately 1 year after COVID-19 infectionDesignRetrospective observational cohort study using surveys and clinical dataParticipantsSurvey respondents who were survivors of acute COVID-19 infection requiring Emergency Department presentation or hospitalization between March 3 and May 15, 2020.Main Measure(s)Self-reported health status, persistent symptoms, and effort toleranceKey ResultsThe 530 respondents (median time between hospital presentation and survey 332 days [IQR 325–344]) had mean age 59.2±16.3 years, 44.5% were female and 70.8% were non-White. Of these, 41.5% reported worse health compared to a year prior, 44.2% reported persistent symptoms, 36.2% reported limitations in lifting/carrying groceries, 35.5% reported limitations climbing one flight of stairs, 38.1% reported limitations bending/kneeling/stooping, and 22.1% reported limitations walking one block. Even those without high-risk comorbid conditions and those seen only in the Emergency Department (but not hospitalized) experienced significant deterioration in health, persistent symptoms, and limitations in effort tolerance. Women (adjusted relative risk ratio [aRRR] 1.26, 95% CI 1.01–1.56), those requiring mechanical ventilation (aRRR 1.48, 1.02–2.14), and people with HIV (aRRR 1.75, 1.14–2.69) were significantly more likely to report persistent symptoms. Age and other risk factors for more severe COVID-19 illness were not associated with increased risk of PASC.ConclusionsPASC may be extraordinarily common 1 year after COVID-19, and these symptoms are sufficiently severe to impact the daily exercise tolerance of patients. PASC symptoms are broadly distributed, are not limited to one specific patient group, and appear to be unrelated to age. These data have implications for vaccine hesitant individuals, policy makers, and physicians managing the emerging longer-term yet unknown impact of the COVID-19 pandemic.Supplementary InformationThe online version contains supplementary material available at 10.1007/s11606-021-07379-z.

The role of dietitian in the multidisciplinary treatment of PCOS

The role of dietitian in the multidisciplinary treatment of PCOS

Pediatric respiratory hospitalizations in small for gestational age neonates born at term.

This study investigates the risk for long-term respiratory hospitalizations of offspring born small for gestational age (SGA) at term. A retrospective population-based cohort analysis was performed to examine the risk of long-term respiratory hospitalizations between SGA compared to appropriate for gestational age (AGA) newborns. The analysis included all term singleton deliveries occurring between 1991 and 2014 at a single tertiary medical center. Fetuses with congenital malformations, multiple gestation, cases of perinatal mortality and large for gestational age (LGA) were excluded. A Kaplan-Meier survival curve was used to compare cumulative morbidity incidence up to the age of 18 years, and a Cox hazards regression model was used to control for confounders. During the study period 216,671 deliveries met the inclusion criteria; of them 4.8% (n = 10,450) were diagnosed as SGA neonates. During the follow-up period, the rate of hospitalization due to respiratory morbidity was significantly higher in the SGA group as compared to the AGA group (5.2% vs. 4.7%, OR = 1.13, 95% confidence interval [CI] = 1.03-1.24, p = 0.011). The Kaplan-Meier survival curve demonstrated a significantly higher cumulative incidence of respiratory morbidity in the SGA group (log-rank p = 0.026). In the Cox hazards regression model, controlled for relevant clinical confounders, SGA was found to be an independent risk factor for long-term pediatric respiratory morbidity (adjusted hazard ratio [HR] = 1.1, 95% CI = 1.001-1.19, p = 0.049). Being delivered SGA at term is an independent long-term risk factor for pediatric respiratory hospitalization.

Long-Term Prognosis and Predictive Risk Factors for Polyvascular Disease in Patients with Peripheral Arterial Disease

Background: The aim of the current study was to assess fifteen-year life expectancy, cardiovascular events, fate of the limb, and risk factors with or without polyvascular disease in patients with Peripheral Arterial Disease (PAD). Methods: We conducted a prospective cohort study in 1019 PAD patients. The endpoints were Cardiovascular or Cerebrovascular Death (CCVD), All-Cause Death (ACD), Major Adverse Cardiovascular Events (MACE), and Cardiovascular and/or Limb Events (CVLE). Results: The patients who died were 539 (52.9%) during follow-up periods. The rate of CCVD was 50.5% (n = 272). In multiple regression analysis, the number of affected arteries had correlations with estimated Glomerular Filtration Rate (eGFR), HDL-cholesterol, Ankle Brachial Pressure Index (ABI), and diabetes (p cholesterol, and diabetes (p CVD and CHD) was correlated with ABI, eGFR, HDL-cholesterol, and diabetes (p The number of affected arteries had significant correlations with CCVD, ACD, MACE, and CVLE (p 0.05). In Cox multivariate analyses, age, Critical Limb Ischemia (CLI), eGFR, albumin, C-Reactive Protein (CRP), Body Mass Index (BMI), CVD, and CHD were related to CCVD (p Conclusions: Polyvascular disease was independently associated with fifteen-year mortality, cardiovascular events, and the fate of the limb with diverse risk factors in PAD patients.

Long-Term Outcome and Risk Factor Analysis of Surgical Pulmonary Valve Replacement in Congenital Heart Disease

Objectives: To establish long-term outcome of surgical pulmonary valve replacement (PVR) in congenital heart disease (CHD) and to identify risk factors for overall mortality, operative mortality, and repetitive PVR. Methods: This is a retrospective study of 375 surgical PVR in 293 patients who underwent surgical PVR for CHD between January 2000 and May 2020. We only included patients with index PVR with previous open-heart surgery regardless of the number of PVRs. The previous surgical history of patients who underwent PVR during the study period was also included. Patients who underwent the Rastelli operation, and those who underwent single PVR without previous open-heart surgery were excluded. Results: The median age of the patients at the time of surgical PVR was 14.9 years (Interquartile range, IQR, 11.0–22.0). The median follow-up duration was 10.5 years (IQR, 5.5–14.8 years). There were 3 patients with operative mortality (1.0%) and 15 patients with overall mortality (5.1%). The survival rate was 95.1% over 20 years follow-up period. Multivariate analysis demonstrated that more than 3 times of previous open-heart surgeries before surgical PVR, older age at the first operation, longer cardiopulmonary bypass (CPB) time and longer intensive care unit (ICU) stay were predictors for overall mortality. Patients who underwent surgical PVR after more than 3 times of previous open-heart surgeries had significantly higher mortality than those who underwent open-heart surgeries less than 3 times (P

The concentration of complexity: case mix in New Zealand general practice and the sustainability of primary care.

Introduction New Zealand general practice and primary care is currently facing significant challenges and opportunities following the impact of the coronavirus disease 2019 (COVID-19) pandemic and the introduction of health sector reform. For future sustainability, it is important to understand the workload associated with differing levels of patient case mix seen in general practice. Aim To assess levels of morbidity and concomitant levels of socio-economic deprivation among primary care practices within a large primary health organisation (PHO) and associated Māori provider network. Methods Routinely collected practice data from a PHO of 57 practices and a Māori provider (PHO) of five medical practices in the same geographical area were used to compare a number of population health indicators between practices that had a high proportion of high needs patients (HPHN) and practices with a low proportion of high needs patients (Non-HPHN). Results When practices in these PHOs are grouped in terms of ethnicity distribution and deprivation scores between the HPHN and Non-HPHN groups, there is significantly increased clustering of both long-term conditions and health outcome risk factors in the HPHN practices. Discussion In this study, population adverse health determinants and established co-morbidities are concentrated into the defined health provider grouping of HPHN practices. This 'concentration of complexity' raises questions about models of care and adequate resourcing for quality primary care in these settings. The findings also highlight the need to develop equitable and appropriate resourcing for all patients in primary care.

Durable outcomes of double cord blood transplantation in adults with acute lymphoblastic leukemia: high-risk features for early and long-term mortality.

Background:Cord blood transplantation (CBT) has been reported as an acceptable option with comparable outcomes to conventional donors in adults with acute lymphoblastic leukemia (ALL). We aimed to analyze the long-term CBT outcomes and risk factors for early and long-term mortalities.Methods:Between 2006 and 2020, 112 patients (median age: 35 years; 62 Ph-negative ALL and 50 Ph-positive ALL) were treated with double CBT. Conditioning regimen consisted of total body irradiation (12 Gy) plus cytarabine (9.0 g/m2) plus fludarabine (150 mg/ m2), and graft-versus-host disease (GVHD) prophylaxis was attempted by administering tacrolimus plus mycophenolate mofetil.Results:The median time for neutrophil and platelet recovery was 25 days (range: 5–59 days) and 34 days (range: 7–185 days), respectively. The cumulative incidence of acute GVHD at 1 year was 43.8%, and the incidence of acute GVHD with grades III–IV was 8.9%. The overall cumulative incidence of chronic GVHD was 22.0%, and the incidence of moderate to severe chronic GVHD was 8.5%. After a median follow-up of 60.1 months (range: 5.7–181.3 months), the 5-year cumulative incidence of relapse (CIR) and nonrelapse mortality (NRM) were 15.9% and 28.5% (9.7% and 27.2% for CR1), respectively, and the 5-year overall survival (OS) was 57.9% (66.5% for CR1). In multivariate analysis of 88 patients receiving double CBT in CR1, delayed CR1 was related to high CIR, and age older than 40 years was associated with high NRM and early mortality. Unexpectedly, Ph-positive ALL with MRD had a higher NRM and early mortality than Ph-negative ALL and Ph-positive ALL without MRD subgroups, possibly due to delayed neutrophil and platelet recovery.Conclusion:Our data suggest that double CBT for adult ALL in CR1 has a greater benefit in younger patients and in patients with Ph-positive ALL without MRD or Ph-negative ALL.

Association of White Matter Hyperintensities with Long-Term EGFR-TKI Treatment and Risk Factors

Association of White Matter Hyperintensities with Long-Term EGFR-TKI Treatment and Risk Factors

Trends in the high blood glucose and non-alcoholic fatty liver disease among Korean adolescents.

High blood glucose level and non-alcoholic fatty liver disease (NAFLD) in adolescents are long-term risk factors for cardiovascular diseases and poor prognosis. We investigated recent trends of high blood glucose levels and NAFLD among Korean adolescents aged 12-18 years. We conducted a cross-sectional analysis using data of 5,685 adolescents aged 12-18 years from the Korea National Health and Nutrition Examination Surveys (KNHANES), from 2007-2009 to 2016-2018. Linear trends in the prevalence of high blood glucose level, NAFLD, and associated factors were assessed using multivariable logistic regression analyses. During the study period, the odds ratios for high blood glucose level and NAFLD increased significantly in both sexes and in girls, respectively (p for trend <0.05). Over-consumption of total calories in boys and fat intake in boys and girls increased significantly (p for trend <0.05). In Korean adolescents, the prevalence of high blood glucose level and NAFLD has increased recently. Efforts to modify the associated factors and further research to determine the public health measures are warranted to prevent these metabolic abnormalities in adolescents.

Crisis resilient strategy: Lessons from the pandemic

Some managers argue that the need for a long-term planning in enterprises is decreasing due to the uncertainty caused by the coronavirus crisis. The analysis of the strategic planning theory does not provide precise recommendations how to counter such a phenomenon. The research is aims at the analysis of existing approaches to the formation of a strategy resistant to long-term risk factors such as a pandemic and taking specific measures to form a sustainable strategy. The format of the strategy has an important role in solving this problem: the formulation of the key indicators of this document. Modern Russian surveys show that modern strategy is a constantly changing document. A strategy format depends on the size of the company. The classical strategic theory is typical of large corporations. However, small companies treat strategy as a vision. The study provides solutions to resilient strategy based on the size of the enterprise such as the transition from a limited strategy to a termless strategy. This document will include a set of strategic decisions on business diversification, cooperation with partners and competitors, etc.

PROFILE OF HISTORY OF FEBRILE SEIZURE IN PATIENTS WITH EPILEPSY

Background: Febrile seizure is convulsions with fever (temperature ³38°C) with no central nervous system infection that commonly found in children (6-60 months). Febrile seizures do not always mean the child has epilepsy. However, febrile seizures can be a possible long-term risk factor for epilepsy. Objective: The objective of this study is to know the profile of febrile seizure in patients with epilepsy. Methods: A retrospective descriptive study on 23 patients with epilepsy in the EEG Department of Neurology, Dr. Soetomo General Hospital, Surabaya, Indonesia in the period 2018-2019 based on inclusion and exclusion criteria. The total number of epilepsy patients is 849 patients, 216 of whom had a history of febrile seizure. Among 216 epilepsy patients who had a history of febrile seizures, 23 of them were qualified as the sample. The sampling technique used was total population sampling. The instrument of this research is the patients’ medical record. Data analysis is carried out descriptively. Results: The characteristics of the history of febrile seizures that found in patients with epilepsy are more patients are male, have the age of onset on less than 2 years old, have the body temperature more than 38.3°C, have the seizure duration less than 15 minutes, have focal seizures, have recurrent seizures in 24 hours, have a history of more than one febrile seizure, have accompanying neurological disorders, and have no family history of epilepsy. Conclusion: Febrile seizure is still becoming a concern because there is a possibility that it may develop into epilepsy. Even though, not all children who experience febrile seizure will generate epilepsy.

Factor V Leiden and the 10-year incidence of depression: A retrospective cohort study conducted in Germany

Factor V Leiden and the 10-year incidence of depression: A retrospective cohort study conducted in Germany

Management of long-term cardiovascular risk factors post organ transplant.

Cardiovascular disease is one of the leading causes of death in solid organ transplant (SOT) recipients. Early identification of cardiovascular risk factors and their adequate management in this population is key for prevention and improved outcomes. Approximately 80% of SOT present one or more cardiovascular risk factors, with increasing prevalence with time posttransplantation. They are due to the interplay of pretransplant conditions and metabolic consequences of immunosuppressive agents, mainly corticosteroids and calcineurin inhibitors. Among the pharmacological management strategies, statins have shown an important protective effect in SOT. Strict surveillance of cardiovascular risk factors is recommended in SOT due to their high prevalence and prognostic implications. Further studies on the best managements strategies in this population are needed.

Risk factors for short and long-term great saphenous vein recanalization in patients treated with endovenous radiofrequency ablation.

The aim of this retrospective single-center study is to describe and analyze short-, mid-, and long-term risk factors for great saphenous vein (GSV) recanalization after endovenous radiofrequency ablation (RFA). All consecutive patients with GSV incompetence and varicose veins underwent RFA were enrolled between 2009 and 2018. Data on demographic, pre- and postoperative color Doppler scan (CDUS) findings, perioperative complications, and follow-up were prospectively collected. Primary outcome was GSV recanalization rate at 1week after RFA. Secondary outcomes were postoperative complication rate, as well as GSV recanalization rate at 1, 3, and 5years after RFA. Risk factors for recanalization were also analyzed, for each follow-up assessment, identifying differences in recanalized (Rec) and non-recanalized (nRec) groups. During the study period, 1297 patients were treated. Among these, 1265 had at least 1week of follow-up. Mean follow-up time was 3.0 ± 1.9years. Recanalization rate at 1week, 1, 3, and 5years was 2.4%, 4.3%, 9.3%, and 17.5%, respectively. After multivariate analysis for each follow-up evaluation, CEAP classes C4 and 5, as well as preoperative GSV diameter >6mm and history of smoking were found to be independent predictors of recanalization. Furthermore, age >61years and postoperative complications such as pigmentation, edema, and paresthesia were found to be dependent risk factors. RFA remains a safe and durable technique to ablate incompetent GSV. Despite this, particular attention should be paid to patients with high CEAP classes to avoid short and long-term recanalization.

An overview of polycystic ovary syndrome in aging women

The manifestations of polycystic ovary syndrome (PCOS), a ubiquitous reproductive disorder, may vary significantly depending on the severity of a number of endocrine and metabolic changes. Although no diagnostic criteria are presently available for PCOS for perimenopausal and menopausal women, the condition can still be suspected in case of a previous diagnosis of the condition, a chronic history of irregular menstrual cycles and hyperandrogenism, and/or polycystic ovarian morphology during the reproductive period. PCOS is associated with long-term health risks, including obesity, diabetes, hypertension, dyslipidemia, metabolic syndrome and cardiovascular risk factors during reproductive age, especially in patients possessing classic phenotypes. The aim of this review was to outline the available data about the impact of PCOS on long-term health risks after reproductive age in patients with PCOS. Previously, it was assumed that women with PCOS would be more prone to develop cardiometabolic diseases after reproductive age but current data suggest that in accordance with the healing in the phenotypic characteristics of PCOS, no deterioration appears to occur in cardiometabolic health in these patients. While there is substantial evidence for a greater prevalence of abnormal subclinical atherosclerotic markers among younger patients with PCOS, data for older women are insufficient. However, there is also support for an increased risk of endometrial cancer in PCOS patients. Extensive prospective cohort studies in which healthy controls as well as patients with defining PCOS phenotypes are observed and monitored from the early reproductive period into the late postmenopausal period should now be performed in order to clarify morbidities and mortality in aging women with PCOS.