Low Risk Research Articles

Comparison of complications and surgery outcomes in skin closure methods following cesarean sections.

This study aimed to assess the impact of absorbable subcutaneous staples for skin closure in cesarean delivery (CD) on maternal morbidity. A retrospective cohort study was conducted at a single tertiary university-affiliated medical center between January 2011 and April 2022. In 2020, a new technique involving absorbable subcutaneous staples for skin closure in CD was introduced. We compared surgical outcomes among three groups: non-absorbable staples, absorbable subcutaneous staples, and absorbable subcutaneous sutures. Data were compared between the three groups and demographic, obstetric, and surgical characteristics were analyzed using univariate and multivariate analysis. During the study period, 31,660 CDs were performed in our center. The data of 31,419 CDs were available for analysis. Absorbable subcutaneous staples were associated with a significantly shorter surgery time in comparison to non-absorbable staples and sutures (52 min vs 53 min vs 60 min, p < 0.001). No differences were found in rates of wound infections or any surgical site surgery in the 45 days following CD. In a multivariate analysis: the use of absorbable subcutaneous staples was associated with a significantly lower risk for prolonged hospitalization > 5 days (OR 0.6, p < 0.001) and re-admission within 45 days (OR 0.8, p = 0.04). The use of absorbable subcutaneous staples for skin closure during CD is associated with shorter surgery times and a lower risk of prolonged hospitalization and readmission within 45 days.

Prospective association between breakfast consumption frequency and BMI z-score among European school-aged children. The Feel4Diabetes Study.

The long-term effects of breakfast on childhood z-BMI remain inconclusive. To prospectively assess the impact of stable and altered breakfast consumption habits on z-BMI change over two years, in school-aged children across six European countries. Data of 6,528 children (8.2 ± 1.0 years, 48.9% male) from the Feel4Diabetes study were used. Children's lifestyle behaviors, including breakfast frequency, were assessed through parent-reported questionnaires. Weight and height were objectively measured and converted to z-BMI. Participants were categorized into trajectories combining breakfast consumption habit (i.e., regular consumption, irregular consumption or omission) at baseline and follow up. Logistic regression analyzed the prospective association between breakfast trajectories and z-BMI increase, with adjustment for demographic and lifestyle variables. A statistically significant effect of breakfast trajectories was observed in z-BMI, both at baseline and follow up. Stable skippers was the only trajectory that showed a significant increase in BMI z-score from baseline to follow up (0.891 ± 1.058 vs. 1.034 ± 1.072 respectively, p < 0.05). BMI z-score at follow up of regular eaters (0.615 ± 0.967) was significantly lower, compared to both irregular eaters (1.229 ± 0.890) and stable skippers (both p < 0.05). Stable regular consumption and transition from omission to regular consumption were independently associated with significantly lower risk of z-BMI gain, compared to stable omission [OR, 95% CI: 0.55 (0.31, 0.97), p = 0.039 and 0.43 (0.21, 0.88), p = 0.021 respectively]. Stable regular breakfast consumption or transition from omission to regular consumption seem to contribute to superior weight regulation in children and to independently protect against z-BMI gain, compared to stable omission. Further studies are warranted to extend the evidence on the breakfast habit-BMI association among children.

Aspirin versus Clopidogrel monotherapy beyond 1 month after complex percutaneous coronary intervention: A pre-specified subgroup analysis of the STOPDAPT-3 trial.

There were no previous studies comparing aspirin versus P2Y12 inhibitor monotherapy following short dual antiplatelet therapy (DAPT) after complex percutaneous coronary intervention (PCI). We conducted a prespecified subgroup analysis based on complex PCI in the 1-year results of the STOPDAPT-3 trial, which randomly compared 1-month DAPT followed by aspirin monotherapy (aspirin group) to 1-month prasugrel monotherapy followed by clopidogrel monotherapy (clopidogrel group). The main analysis in the present study was the 30-day landmark analysis. The co-primary endpoints were cardiovascular events (a composite of cardiovascular death, myocardial infarction, definite stent thrombosis, or stroke) and major bleeding (Bleeding Academic Research Consortium 3 or 5). In the 30-day landmark analysis (N=5833), there were 1415 patients (24.3%) who underwent complex PCI. There was a significant interaction between complex PCI and the effect of aspirin group relative to clopidogrel group for cardiovascular events (complex PCI: 3.3% versus 5.2%, non-complex PCI, 4.3% versus 3.6%, interaction P=0.04) and net adverse clinical events (complex PCI: 4.8% versus 7.2%, non-complex PCI: 5.3% versus 4.4%, interaction P=0.02), but not for bleeding events (complex PCI: 2.1% versus 2.7%, non-complex PCI: 1.7% versus 1.4%, interaction P=0.35). There was a significant interaction between complex PCI and the effect of aspirin monotherapy relative to clopidogrel monotherapy beyond 1 month and up to 1 year for cardiovascular events due to numerically lower risk of aspirin monotherapy in patients with complex PCI, while the effect of aspirin monotherapy relative to clopidogrel monotherapy was not different for bleeding regardless of complex PCI. Clinical trial registration: ShorT and OPtimal duration of Dual AntiPlatelet Therapy after everolimus-eluting cobalt-chromium stent-3 [STOPDAPT-3]; NCT04609111.

Sex-Specific Clinical and Genetic Factors Associated With Adverse Outcomes in Hypertrophic Cardiomyopathy.

Females with hypertrophic cardiomyopathy present at a more advanced stage of the disease and have a higher risk of heart failure and death. The factors behind these differences are unclear. We aimed to investigate sex-related differences in clinical and genetic factors affecting adverse outcomes in the Sarcomeric Human Cardiomyopathy Registry. Cox proportional hazard models were fit with a sex interaction term to determine if significant sex differences existed in the association between risk factors and outcomes. Models were fit separately for females and males to find the sex-specific hazard ratio (HR). After a mean follow-up of 6.4 years, females had a higher risk of heart failure (HR, 1.51 [95% CI, 1.21-1.88]; P=0.0003) but a lower risk of atrial fibrillation (HR, 0.74 [95% CI, 0.59-0.93]; P<0.0001) and ventricular arrhythmia (HR, 0.60 [95% CI, 0.38-0.94]; P=0.027) than males. No sex difference was observed for death (P=0.84). Sarcomere-positive males had higher heart failure (HR, 1.34 [95% CI, 1.06-1.69]) and death risks (HR, 1.48 [95% CI, 1.08-2.04]) not seen in females (HR, 0.85 [95% CI, 0.66-1.08] versus HR, 0.86 [95% CI, 0.71-1.21]). MYBPC3 variants lowered heart failure risk in females (HR, 0.56 [95% CI, 0.41-0.77]) but not in males (HR, 1.29 [95% CI, 0.99-1.67]). A sex difference appeared in moderate (4% to <6%) versus low risk (<4%) European Society of Cardiology hypertrophic cardiomyopathy risk score, with females at moderate risk more prone to ventricular arrhythmia (HR, 3.57 [95% CI, 1.70-7.49]), unobserved in males (HR, 1.13 [95% CI, 0.63-2.03]). We found that clinical and genetic factors contributing to adverse outcomes in hypertrophic cardiomyopathy affect females and males differently. Thus, research to inform sex-specific management of hypertrophic cardiomyopathy could improve outcomes for both sexes.

Associations between domestic hard water exposure and incident psoriasis in adults: Insights from the UK Biobank cohort study.

Although exposure to hard water is associated with various inflammatory skin conditions, the specific relationship between hard water and psoriasis has not been clearly defined. We analyzed data from 486,414 participants in the UK Biobank cohort to explore the association between domestic hard water exposure and the incidence of psoriasis. Domestic water hardness, measured in calcium carbonate concentration, was obtained in 2005 from local water providers in Wales, Scotland, and England. During a median follow-up period of approximately 14 years, a total of 4801 (1.0%) participants reported psoriasis, and we observed that for every 50mg/L increase in water hardness (as CaCO₃), there was a 3% increase in the risk of psoriasis [Hazard Ratio (HR)=1.03, 95% Confidence Interval (CI) 1.01-1.06]. Individuals exposed to very hard water (>180mg/L) exhibited a 20% increased risk of psoriasis compared to those exposed to soft water (0-60mg/L) [HR: 1.20, 95% CI: 1.07-1.34]. A positive linear relationship was observed between water hardness and the risk of psoriasis. Furthermore, the polygenic risk score indicated a synergistic effect between hard water exposure and genetic risk factors in developing psoriasis. Subgroup analysis suggested that the effect of hard water on psoriasis is more pronounced in individuals with a low polygenic risk score, women, the elderly, non-obese individuals, those of high socioeconomic status or without dyslipidemia. Residential water hardness has been identified as a significant risk factor for psoriasis in adults. Sustained efforts to reduce exposure to hard water may alleviate the psoriasis burden.

Cutting-edge insights into liver fibrosis: advanced therapeutic strategies and future perspectives using engineered mesenchymal stem cell-derived exosomes.

Liver fibrosis is still a serious health concern worldwide, and there is increasing interest in mesenchymal stem cells (MSCs) with tremendous potential for treating this disease because of their regenerative and paracrine effects. Recently, many researches have focused on using the released exosomes (EXOs) from stem cells to treat liver fibrosis rather than using parent stem cells themselves. MSC-derived EXOs (MSC-EXOs) have demonstrated favourable outcomes similar to cell treatment in terms of regenerative, immunomodulatory, anti-apoptotic, anti-oxidant, anti-necroptotic, anti-inflammatory and anti-fibrotic actions in several models of liver fibrosis. EXOs are superior to their parent cells in several terms, including lower immunogenicity and risk of tumour formation. However, maintaining the stability and efficacy of EXOs after in vivo transplantation remains a major challenge in their clinical applicability. Therefore, several strategies have been applied in EXOs engineering, such as parental cell modification or modifying EXOs directly to achieve optimum performance of EXOs in treating liver fibrosis. Herein, we discuss the underlying mechanisms of liver fibrosis with an overview of the available therapies, among them EXOs. We also summarise the recent developments in improving the effectiveness of EXOs with the advantages and limitations of these approaches in terms of the upcoming clinical applications.

Dose-response analysis of music intervention for improving delirium in intensive care unit patients: A systematic review and meta-analysis.

Delirium is a common and severe condition among adult intensive care unit (ICU) patients. Music intervention, as a non-pharmacological approach, has the potential to reduce delirium, but the optimal dosage and type of intervention remain unclear. To explore the effects of music intervention at different doses and types on reducing delirium in ICU patients. This study was conducted as a systematic review and meta-analysis. Databases including Cochrane Library, EBSCO, Embase, PubMed, Web of Science, Airiti Library, China National Knowledge Infrastructure and Wanfang Data were searched until 29 February 2024. Study quality was assessed using the Cochrane Risk of Bias 2.0 criteria. Data were analysed using RevMan 5.4.1 and Comprehensive Meta-Analysis 3.0. Fourteen studies involving 1434 ICU patients were included. Four studies were of good quality (low risk of bias), seven were of moderate quality (unclear risk) and three were of low quality (high risk). Pooled analysis showed that music interventions significantly reduced the risk of delirium (12 studies, RR = .49, 95% confidence interval [CI] [.40, .61]). Slow-tempo music had the strongest effect (11 studies, RR = .46, 95% CI [.37, .57]). The optimal intervention dosage involves conducting music interventions twice daily (12 studies, RR = .46, 95% CI [.34, .63]), with each session lasting 30 min (12 studies, RR = .41, 95% CI [.30, .55]). Additionally, a pooled analysis showed that a 7-day music intervention (6 studies, RR = .43, 95% CI [.26, .71]) was the most effective in reducing the risk of delirium. Music intervention reduces delirium in ICU patients, especially with two 30-min sessions daily for 7 days. However, the certainty of evidence is low, highlighting the need for further high-quality research. Music intervention is a simple, non-invasive method that may help reduce delirium in ICU patients. However, given the low certainty of the current evidence, it should be used cautiously, and further research is needed to validate its effectiveness before routine implementation.

Impact of vitamin D supplementation on symptom severity and quality of life in patients with irritable bowel syndrome: A meta-analysis.

Vitamin D supplementation could offer irritable bowel syndrome (IBS) patients significant improvements in terms of symptom severity and overall quality of life (QoL). Yet, the potential benefits and risks associated with vitamin D supplementation still require additional investigation. We aimed to evaluate the impact of vitamin D supplementation on IBS using a systematic review and meta-analysis. A comprehensive search was carried out utilizing 4 electronic databases (PubMed, Embase, Scopus, and Cochrane Library) to identify articles published in English-language peer-reviewed journals. The odds ratios (ORs), risk ratios (RRs) and mean differences (MDs), along with their respective 95% confidence intervals (95% CIs), were computed. Heterogeneity was evaluated using the appropriate p-value and Cochrane Q and I2 statistics. For the analysis, RevMan 5.3 was utilized. Nine randomized controlled trials involving a total of 780 participants were included in this study. Vitamin D supplementation, in adolescents and young adults with IBS, improves the IBS symptoms severity score, QoL and serum 25(OH)D levels compared to controls. We obtained an OR of 2.34 (95% CI: 1.56-3.50) for change in the IBS severity scoring system (IBS-SSS), OR = 2.51 (95% CI: 1.71-3.70) for change in QoL, low risk of any adverse events (RR 0.49 (95% CI: 0.35-0.69)), and substantial changes in serum 25(OH)D level (MD = 11.29 (95% CI: 7.13-15.45)). Results were statistically significant (p < 0.05). Vitamin D supplementation could lead to better IBS management with a low risk of adverse events.

Evaluating Efficacy and Safety of Crisaborole in Managing Childhood Mild to Moderate Atopic Dermatitis: A Systematic Review and Meta-Analysis.

Aims/Background Atopic dermatitis (AD) is a common chronic inflammatory skin disorder globally. Crisaborole, a nonsteroidal topical phosphodiesterase 4 inhibitor (PDE4i), has been utilized in treating AD. Crisaborole regulates the production of inflammatory cytokines, which are usually overactive among AD patients. Therefore, this study aimed to explore the efficacy and safety of crisaborole in treating AD in patients aged ≤18 years. Methods A literature search was performed across PubMed, MEDLINE, Embase, Cochrane, and Google Scholar. The inclusion criteria involved primary studies evaluating the effect of crisaborole in treating dermatitis, articles exploring the use of crisaborole in AD patients below 18 years (>two years), and articles published in English between 2000 and 2022. However, the studies evaluating AD in adult patients, those reporting treatments other than crisaborole, those published before 2000, and articles written in languages other than English were excluded from this analysis. Furthermore, secondary data sources such as case reports, newspaper articles, magazines, and other systematic reviews and meta-analyses were excluded. A meta-analysis was conducted using RevMan 5.4. The risk of bias in the manuscripts was assessed using the Cochrane tool. The I-square test statistic was used to determine heterogeneity, and Egger's test was used to evaluate publication bias. Results Ten studies met the eligibility criteria and were included in the final analysis. Most of the studies exhibited a low risk of bias with no publication bias. Meta-analysis indicated a significant difference in the number of patients attaining Investigator Static Global Assessment (ISGA) success at day 29, with significantly higher patients in the crisaborole group than in the vehicle group (odds ratio (OR) 1.56, 95% CI 1.24 to 1.96; I2 = 77%; p = 0.0001). Similarly, pruritus improvement was significant between the two cohorts at day 29, indicating significantly higher heterogeneity (OR 1.70, 95% CI 1.10 to 2.63; I2 = 91%; p = 0.02). Furthermore, the safety profiling of the treatments was insignificant, demonstrating no statistical difference in the treatment-emergent adverse events (TEAEs) between the two groups with high heterogeneity (OR 0.53, 95% CI 0.14 to 1.98; I2 = 99%; p = 0.35). Conclusion Crisaborole demonstrates substantial efficacy in treating mild to moderate AD compared to vehicle therapies, as it reduces the signs and symptoms of the disease. Furthermore, crisaborole is well tolerated and has an acceptable safety profile in treating mild to moderate AD patients.

Clinical difference between solitary and multiple pulmonary adenocarcinoma nodules.

we compared and analyzed the imaging features, tumor markers, pathological immunohistochemistry, and lymph node metastasis rates of solitary and multiple lung adenocarcinoma to provide a valuable reference for clinical diagnosis and treatment. A retrospective analysis of 212 patients who underwent thoracic surgery in our hospital from 2022 to 2023, including 149 patients with a solitary lung adenocarcinoma nodule and 63 patients with multiple primary nodules. Via propensity score matching, the imaging features, tumor serological markers, pathological immunohistochemistry, and lymph node metastasis rates of the two groups were compared, and the differences in lymph node metastasis rates between solitary and multiple nodules were explored by binary logistic regression. After propensity score matching, there were significant differences in the mean CT value (P = 0.001), Ki-67 expression (P < 0.001), PD-L1 expression (P = 0.002), and the lymph node metastasis rate (P = 0.030) between the two groups, but there were no significant differences in nodule type, imaging features, tumor serological marker levels, and the ALK-positive and SYN-positive rates. With lymph node metastasis as the dependent variable, solitary or multiple nodules as the categorical covariate, and the three variables were included as independent variables for binary logistic regression analysis. The probability of lymph node metastasis was 80.8% lower in patients with multiple primary lung adenocarcinoma nodules than in those with a solitary one (P = 0.042). Multiple primary adenocarcinoma nodules exhibit milder biological behavior than solitary adenocarcinoma nodules and carry a lower risk of lymph node metastasis.

Circulating inflammatory cytokines and colorectal cancer: New insights from Mendelian randomization.

Colorectal cancer (CRC) is one of the most common cancers worldwide and inflammation is believed to play an important role in CRC. In this study, we comprehensively analyzed the causal association between 91 circulating inflammatory cytokines and the risk of CRC using Mendelian randomization (MR). Based on genome-wide association study summary statistics, we examined the causal effects of 91 circulating inflammatory cytokines on CRC. A series of MR methods, including bidirectional MR, replication sample MR, and multivariable MR, were employed to provide more robust causal estimates. After the validation with 3 MR methods and a series of sensitivity analyses, 2 circulating inflammatory factors were found to be significantly associated with the risk of CRC at the genetic level. Specifically, genetically predicted circulating levels of glial cell line-derived neurotrophic factor (GDNF) (OR = 1.12; 95% CI: 1.05-1.19; P = 2.72 × 10-4) and tumor necrosis factor-related apoptosis-inducing ligand (TRAIL) (OR = 0.93; 95% CI: 0.91-0.99; P = 1.00 × 10-2) exerted causal effects on CRC risk. In conclusion, this study suggests that increased circulating levels of GDNF and TRAIL are associated with a higher and lower risk of CRC, respectively. GDNF and TRAIL may be 2 potential therapeutic targets that deserve future investigation.

Elucidating the Causal Link Between Treg-Related Immune Traits and Atherosclerosis-Related Cardiovascular Diseases: A Bidirectional Mendelian Randomisation Analysis

Regulatory T cells (Tregs) play a crucial role in the development and progression of atherosclerosis. However, the specific association between Treg immune traits and atherosclerosis and related cardiovascular diseases remains unclear, impeding their potential for clinical therapeutic application. Fifty-eight Treg-related immune traits were obtained from the latest summary level genome-wide association study, which included 3,757 individuals from Sardinia. Additionally, three atherosclerosis subsets and three atherosclerosis-related cardiovascular diseases were obtained from the FinnGen database. Subsequently, comprehensive bidirectional Mendelian randomisation (MR) analysis was performed using inverse-variance weighting as the primary method. Sensitivity analyses were performed to verify the robustness, heterogeneity, and horizontal pleiotropy of the results. Co-localisation analysis was performed to detect whether the exposure and outcome shared causal variants. Four significant Treg-related immune traits linked to a lower risk of three cardiovascular diseases were identified in the forward MR analysis. Specifically, two traits were identified for cerebral atherosclerosis: CD39+ activated CD4+ Treg absolute count (OR 0.70, 95% CI 0.57-0.87, pFDR=0.040 [false discovery rate]) and activated CD4 Tregs % CD4+ T cells (OR 0.64, 95% CI 0.48-0.84, pFDR=0.040). In addition, CD28 on secreting CD4 Tregs (OR 0.95, 95% CI 0.93-0.98, pFDR=0.014) was detected for other atherosclerosis. In ischaemic heart disease, CD28 on activated CD4 Tregs was protective (OR 0.96, 95% CI 0.95-0.98, pFDR=0.020). An increased intensity of CD3 and CD4 was observed in reverse MR after the occurrence of stroke and ischaemic heart disease, respectively, whereas a lower number and proportion of CD39+-secreting CD4 Tregs were noted after ischaemic heart disease. Co-localisation analysis indicated that there were no shared causal variants among significant associations in forward MR. This study revealed a potential causal relationship between Tregs and atherosclerosis and related cardiovascular diseases, providing a plausible hypothesis for future clinical and basic research.

Maternal-Newborn ABO Blood Group Congruence Among Consecutive Births and Risk of Serious Neonatal Infection: Retrospective Cohort Study.

Differing ABO blood groups between a mother and her fetus may confer a lower risk of serious neonatal infection. How sensitization in the first pregnancy influences this phenomenon in a subsequent pregnancy is unclear. Accordingly, this study determined whether maternal-newborn ABO blood group incongruence in a first pregnancy further modifies the risk of serious infection in a subsequent pregnancy marked by ABO incongruency. This population-based retrospective cohort study used linked patient-level datasets in Ontario, Canada, from 2008 to 2022. Included were mothers with 2 consecutive live births, with recorded maternal and newborn ABO blood group data. The exposure considered both first- and second-born siblings' ABO blood group congruency with their mother. The outcome was a serious neonatal infection within 27 days after birth. Logistic regression models generated adjusted odds ratios (aORs) and 95% confidence intervals (CIs), adjusted for gestational age at birth. Included were 14,739 mother-infant triads. Relative to maternal-newborn congruency in the second pregnancy, incongruent ABO blood groups in the second pregnancy were associated with an aOR of 0.72 (95% CI, 0.53-0.97) for a serious neonatal infection arising in the second-born infant. However, if the first and second siblings each had incongruent ABO blood groups with their mother, the aOR of serious infection in the second-born infant was not significantly lower [0.74 (95% CI, 0.52-1.06)]. Second-born infants whose ABO blood group was incongruent with that of their mother had a lower risk of serious neonatal infection. However, ABO incongruence from a prior birth did not modify that relation.

The Impact of Postoperative Prophylactic Medication on Long-Term Surgical, Severe Endoscopic and Endoscopic or Radiologic Recurrence Following Primary Ileocecal Resection in Patients With Crohn's Disease.

The impact of prophylactic medication following ileocecal resection (ICR) for Crohn's disease (CD) merits further elucidation. Prophylactic medication following ileocecal resection (ICR) is recommended in patients with Crohn's disease (CD), particularly in patients at increased risk of recurrence, but the impact on long-term outcomes needs to be further elucidated. To evaluate the effect of postoperative prophylactic medication on long-term prognosis. A retrospective cohort study was performed in patients with CD who underwent primary ICR between 2000-2020 in the Netherlands. Patients were divided into two groups: postoperative prophylactic medication [< 12 weeks following ICR] versus no postoperative prophylactic medication. Outcomes were surgical recurrence [re-resection for CD], severe endoscopic recurrence [modified Rutgeerts score (mRS) ≥ i3] and endoscopic or radiologic recurrence [mRS ≥ i2b or radiologic recurrence]. Inverse probability of treatment weighting [IPTW] method was used to adjust for confounding and selection bias. Survival and association between postoperative prophylactic medication and outcomes were assessed with Kaplan-Meier analyses and Cox proportional hazard models. 807 patients underwent ICR (median follow-up 5.0 years); 36% received postoperative prophylactic medication. Surgical, severe endoscopic and endoscopic or radiologic recurrence rates were significantly lower in those who received prophylactic medication (p = 0.01; p < 0.01; p < 0.01). IPTW analysis showed a lower risk of severe endoscopic and endoscopic or radiologic recurrence in patients treated with postoperative prophylactic medication (aOR 0.64; 95% CI 0.43-0.97; aOR 0.65; 95% CI 0.47-0.91), which also was identified as a protective factor for severe endoscopic (aHR 0.5; 95% CI 0.4-0.6) and endoscopic or radiologic recurrence (aHR 0.6, 95% CI 0.5-0.7) in multivariable analysis after correction for confounding factors. A comparable protective effect of postoperative prophylactic medication was sustained in patients who underwent ileocolonoscopy <1 year postoperatively and who underwent surgery on or after 2010. Prophylactic medication following primary ICR significantly reduces long-term recurrence rates in CD and was identified as a protective factor for severe endoscopic and endoscopic or radiologic recurrence.

Impact of a personalized, strike early and strong lipid-lowering approach on LDL-cholesterol levels and cardiovascular outcome in patients with acute myocardial infarction.

Considering the lack of evidence, we evaluated the impact on cardiovascular outcome of the systematic introduction in our institution of a personalized strike early and strong (SES) approach for lipid-lowering therapy (LLT) in patients admitted for acute myocardial infarction (MI). We retrospectively analyzed data from 500 consecutive patients hospitalized across three periods: Period A (N=198, January-June 2019), when the LDL-C goal was <70 mg/dL and a stepwise LLT approach was recommended; Period B (N=180, January-June 2021), when the LDL-C goal was <55 mg/dL and a stepwise approach was recommended; Period C (N=122, January-June 2023), when the LDL-C goal was <55 mg/dL and our SES protocol was implemented. Primary endpoints were achievement of the LDL-C goal during follow-up and one-year incidence of major adverse cardiovascular events (MACE). Compared to the other periods, in Period C there was a higher use of potent statins, alone or in combination with ezetimibe, and of PCSK9 inhibitors at discharge. This translated into higher achievement of the LDL-C goal (83% vs 55% in Period A and 43% in Period B; p<0.001) and reduced incidence of MACE (3% vs 12% and 11%; p=0.026). MACE rates were lowest in patients with early and sustained LDL-C <55 mg/dL and in those achieving both LDL-C <55 mg/dL and ≥50% LDL-C reduction. The systematic introduction of a personalized, SES strategy for LLT in patients with acute MI led to greater achievement of LDL-C goal and lower risk of MACE at one year vs the stepwise approach.

Alkaline phosphatase of late pregnancy promotes the prediction of adverse birth outcomes.

Adverse birth outcomes (ABO), such as preterm birth (PTB), small and large for gestational age (SGA/LGA), can compromise both the short- and long-term health of mothers and their foetuses. The purpose of this observational study was to investigate the association between maternal serum alkaline phosphatase (ALP) levels in late pregnancy and the risk of ABO, and to evaluate its predictive value of maternal ALP levels for ABO in women with singleton pregnancies. A total of 11 853 consecutive pregnant women underwent hepatic and renal function tests, lipid profile assessments, ALP and high-sensitivity C-reactive protein levels measurements upon admission for labour. Their clinical perinatal parameters and outcomes were also analysed. The prevalence of PTB, SGA, and LGA in this study was 7.2% (n = 849), 8.9% (n = 1053), and 15.6% (n = 1844), respectively. With increasing quartiles of maternal serum ALP levels, the foetal gestational age increased by 0.58 weeks (95% confidence interval (CI) = 0.50-0.66), 0.78 weeks (95% CI = 0.70-0.86), and 0.98 weeks (95% CI = 0.90-1.06), respectively, and the birth weight increased by 62.91 g (95% CI = 43.96-81.86), 91.54 g (95% CI = 72.41-110.67), and 117.92 g (95% CI = 98.18-137.67), respectively. Compared to women in the bottom quartile of ALP, those in the top quartile had a lower risk of PTB (adjusted odds ratio (OR) = 0.14; 95% CI = 0.11-0.18), a lower risk of SGA (adjusted OR = 0.65; 95% CI = 0.53-0.80), and a higher risk of LGA (adjusted OR = 1.92; 95% CI = 1.62-2.28). Sensitivity analyses conducted among individuals without advanced maternal age, obesity, multiparity, pregnancy complications, and PTB (for SGA/LGA) validated the consistency of these results. More importantly, adding ALP to the established model significantly increased the area under the curve (AUC) for predicting adverse birth outcomes: for PTB, the AUC increased from 0.761 to 0.809 (P < 0.001); for SGA, it increased from 0.754 to 0.759 (P = 0.014); and for LGA, it increased from 0.750 to 0.755 (P < 0.001). Maternal serum ALP levels in late pregnancy are significantly associated with the risk of ABO. When combined with clinical characteristics and routine laboratory results, ALP has incremental predictive value for ABO, particularly for PTB.

Therapeutic quality of exercise interventions for chronic low back pain: a meta-research study using i-CONTENT tool

ObjectiveTo assess the therapeutic quality of exercise interventions delivered in chronic low back pain (cLBP) trials using the international Consensus on Therapeutic Exercise aNd Training (i-CONTENT) tool and its inter-rater...

Planetary Health Diet Index in relation to mortality in a prospective cohort study of U.S. Black females.

To improve both human health and the health of our planet, the EAT-Lancet Commission proposed the planetary health diet (PHD). We aimed to evaluate associations of PHD with all-cause, cardiovascular disease (CVD), and cancer-specific mortality among U.S. Black females. The Black Women's Health Study is a prospective study of self-identified U.S. Black females. In 2001, 33,824 participants free of cancer and CVD completed a validated food frequency questionnaire. PHD Index (PHDI) was calculated based on reported consumption of 15 food groups, such as whole grains, non-starchy vegetables, legumes, soy foods, added fat and trans fat, and red/processed meats. Deaths were identified through linkage to the National Death Index. Cox proportional hazards regression, stratified by age and adjusted for smoking status, body mass index, and other CVD risk factors, was used to calculate hazards ratios (HRs) for quintiles of PHDI in relation to all-cause, CVD-, and cancer-specific mortality. During 18 years of follow-up, we identified 3537 deaths, including 779 from CVD and 1625 from cancer. Females in the quintile representing highest adherence to PHD were estimated to have a 18% reduction in risk of all-cause mortality (HR=0.82, 95% CI: 0.71, 0.94) and 26% reduction in CVD-specific mortality (HR=0.74, 95% CI: 0.55, 0.98), compared to those in the lowest quintile, with similar reductions observed for quintiles 2, 3, and 4. Among individuals under age 55, there was a significant trend of lower CVD mortality risk with higher level of adherence to PHD (p trend=0.004) and the HR for the highest versus lowest quintile was 0.43 (95% CI: 0.21, 0.87). PHDI was not associated with cancer-specific mortality. Adherence to a diet that has been shown to benefit the planet was associated with a lower risk of mortality among Black females, primarily driven by reduction in CVD-specific mortality risk.

Determination of Cyazofamid and Its Metabolite in Rice Based on Magnetic Zirconia Nanoparticles Sample Cleanup and Its Application to a Dissipation and Residue Study.

An analytical method was developed for the determination of cyazofamid (CZFM) and its metabolite CCIM in rice, employing magnetic zirconia nanoparticles (MZNPs) for sample cleanup. MZNPs were synthesized through a one-step hydrothermal process and characterized by multiple techniques. Samples of rice plant, rice hull, and brown rice were extracted using acetonitrile/water, followed by salting out. MZNPs removed the most coextract compared with primary secondary amine (PSA) and zirconia-coated silica (Z-Sep). Satisfactory recoveries (79.6-95.7%; n = 5) of the analytes were acquired with RSDs less than 9.6%. The linearity was good (r > 0.999) over 0.001-1 mg L-1. The LOQs were 0.01 mg kg-1. The dissipation and residues of CZFM were studied as the method application. Half-lives of CZFM in rice plants were calculated to be 4.5-9.8 days. At harvest, residues of CZFM > LOQ were not detected in brown rice, indicating a low dietary risk.

Differential Risk Profiles of Incident Abdominal Aortic Aneurysms in Specific Subgroups: A Large Cohort-based Study.

The aim of this study is to explore the risk profiles associated with Abdominal aortic aneurysm (AAA) incidence in both the general population and diverse subpopulations. AAA is a life-threatening arterial disease, and there is limited understanding of its etiological spectrum across the age, sex, and genetic risk subgroups, making early prevention efforts more complicated. This study encompassed a sample size of 364399 participants from the UK. Utilizing the Cox proportional hazards model, we estimated the hazard ratios (HRs) and population attributable fraction (PAF) for 24 risk factors and 5 weighted risk scores associated with AAA incidence. Subsequently, this study investigated the relationships between AAA onset and various risk factors based on age, sex, and genetic susceptibility subgroups, and assessed the two- and three-way interactions. After a median follow-up of 12.62 years, 1684 participants developed AAA. Among the 24 risk factors from 5 different aspects, 12 exhibited significant associations with AAA development. Socio-demographic factors (age and sex) and genetic factors accounted for the majority of AAA cases in both the general population and diverse subpopulations. For lifestyle factors, AAA cases attributable to smoking are larger in the older group (PAF: 15.45% vs. 11.25%) and women (PAF: 23.79% vs. 16.75%). Similarly, physical inactivity had a greater effect on AAA risk in women (4.84% vs. 1.95%), but no age and genetic risk differences were observed. PAF of high C-reactive protein was the most prominent of all cardiometabolic factors across different age, sex, and genetic risk strata, with 18.92% (< 60 years) and 13.71% (≥ 60 years) in age groups, 18.18% (women) and 13.31% (men) in sex groups, and 17.64% (intermediate genetic risk) and 13.01% (high genetic risk) in genetic risk groups. Clinical comorbidities, such as cardiovascular diseases, dyslipidemia, and hypertension significantly associated with the risk of incident AAA, and these factors exerted a greater influence on AAA risk in younger group, women, and those with low genetic risk (P for interaction < 0.05). This study depicted specific risk profiles that influence AAA incidence among general population and diverse subpopulations, thereby aiding in the formulation of precise and effective strategies for AAA prevention.