Male Ratio Research Articles

Time-trends of sex differences in stroke risk in atrial fibrillation: Are female patients still at higher risk today? A nationwide cohort study

Abstract Background Female sex is associated with higher risk of stroke in patients with atrial fibrillation (AF), particularly in the presence of other stroke risk factors. This has implications for oral anticoagulant treatment (OAC) decision-making, based on points of the CHA2DS2-VASc score. However, stroke rates have declined over recent years, and management has evolved over time towards a holistic approach that may have diminished the sex differences in AF-related stroke. Purpose To examine the changes in stroke risk over time in relation to risk differences between males and females not treated with oral anticoagulants in a nationwide cohort study. Methods This was an observational cohort study including patients with a hospital diagnosis of AF between 2007 and 2021. Data were obtained from the Danish nationwide registries. We identified a cohort of adult patients who were not receiving OAC treatment for up to 30 days after their AF diagnosis. Patients were followed up for thromboembolic events within one year after the AF diagnosis. Survival analysis was applied to describe the yearly rate of events and to estimate the risk ratio for females vs males of thromboembolism according to baseline risk levels, i.e., the CHA2DS2-VA score level (leaving out the ‘Sc’ sex criterion). Results A total of 188,704 AF patients (median age 75 years (IQR: 64 to 84); 49.7% female) who did not receive OAC treatment were included. The risk of thromboembolism during the entire study period was overall higher in females (3.5% in males vs. 4.7% among females). The overall one-year thromboembolic risk declined over time from 4.9% between 1997-2000 to 3.3% between 2017-2020, with male-female risk differences less evident in recent years (Figure 1a). The relative risk of stroke diminished from 1.22 (95%CI 1.10-1.34) in years 1997-2000 to 1.02 (95%CI 0.85-1.19) in years 2017-2020 for patients with a CHA2DS2-VA score of ≥2 (Figure 1b). For patients with a score of <2, the relative risk was lowest between 2005-2008 (1.02 (95%CI 0.63-1.42)) and was 1.18 (95%CI 0.54-1.83) in the latest time period. Formal statistical test for time trends according to score level revealed non-significant results (p-value=0.10 for score 0-1; p-value=0.17 for score levels of ≥2). Conclusion The risk of stroke among patients with AF has been declining over the last two decades. The excess stroke risk observed among females relative to males has also diminished, most evident among AF patients with ≥2 prevalent stroke risk factors.

AV nodal ablation in atrial fibrillation: long term outcomes

Abstract Background Ablation of the atrioventricular (AV) node, following the insertion of a permanent pacemaker, is a treatment option for symptomatic atrial fibrillation (AF) where rate control is poor, despite maximally tolerated pharmacological intervention or percutaneous AF ablation [1], and yet there is limited data on long-term outcomes. Purpose The purpose of this study is to investigate post AV node ablation follow up outcomes, including the incidence and timeframe of conversion of paroxysmal to persistent AF; incidence and timeframe of upgrade to biventricular pacemakers; and mortality. Methods This observational descriptive study looked at the post-procedure follow-up outcomes of patients who underwent AV node ablation at our centre between March 2015 and June 2019. Retrospective analysis of prospectively collected data was analysed. The demographics of the patients, including their age, gender, co-morbidities, pre-ablation left ventricular ejection fraction (LVEF) and medications were recorded. The follow up outcomes investigated included the change in LVEF, the proportion of patients whose AF converted from paroxysmal to persistent, the proportion of patients requiring upgrade to biventricular devices, and deaths within 6 months of ablation. Outcomes were compared between those who had a biventricular pacemaker pre-ablation and those who had single/dual chamber pacemakers. Results 296 patients with a mean age of 72.7± 8.5 years and a female to male ratio of 54.1% : 45.9% were included. 94 patients (31.8%) had paroxysmal AF pre- ablation. 51.6% of those who had paroxysmal AF pre-ablation converted to persistent AF over a median period of 3 years (interquartile range, 3 years). Among those who had a biventricular pacemaker pre-ablation, 56.5% of those with paroxysmal AF converted to persistent, compared to 47.4% of those with a dual pacemaker pre-ablation p=ns Among patients with dual chamber pacemakers, those who remained in paroxysmal AF post-ablation had a mean CHADVASC score of 3.2 (range of 1-6) compared to 3.7 (range of 2-6) in those whose AF converted to persistent (p=0.19). 9 patients (3%) died within less than 6 months of the procedure, with 1 patient dying within 6 days. 13% of the patients originally having a single or dual chamber pacemaker required an upgrade to a biventricular pacemaker over a median period of 1.25 years (interquartile range 1.1 years). All the patients who required an upgrade to a biventricular pacemaker had normal LVEF pre-ablation except for one patient who had mild LV impairment. Conclusions A significant proportion of patients with paroxysmal AF converted to persistent AF following AV node ablation and having a biventricular pacemaker did not offer benefit in keeping people in paroxysmal AF.A considerable number of people required an upgrade to biventricular pacemaker over a short time frame even though they had normal LVEF pre AV nodal ablation.

#2040 Effect of donor–recipient size mismatch on long-term graft survival in pediatric kidney transplantation: a multicenter cohort study

Abstract Background and Aims Kidney transplantation (KT) is the main treatment option for patients with end-stage kidney disease (ESKD). However, it is limited by the low number of donor organs. Moreover, donor–recipient size mismatching is a common problem in KT given the various types of donors. Donor–recipient size mismatching is commonly occurs in pediatric kidney transplantation (KT). However, its effect on graft survival remains unknown. This study aimed to determine the effect of donor–recipient size mismatch on the long-term survival rate of transplant kidneys in pediatric KT. Method A total of 241 pediatric patients who received KT were enrolled. The medical records of all patients were retrospectively reviewed, and the correlation between donor–recipient size mismatch and graft function and long-term graft outcome was analyzed according to donor–recipient size mismatch. Results Recipients and donors’ mean body weight at the time of KT were 34.31 ± 16.85 and 56.53 ± 16.73 kg, respectively. The mean follow-up duration was 96.49 ± 52.98 months. The mean age of donors was 34.74 ± 14.91 years, and the ratio of males and females was 105:136. Approximately 81.7%, 1.2%, and 17.0% of all transplant donors were identified as living-related, living-unrelated, and deceased donors, respectively. A significant positive correlation was observed between donor–recipient body weight ratio (DRBWR) or donor–recipient body surface area ratio (DRBSR) and graft function until 1 year after KT. However, this correlation could not be confirmed at the last follow-up. The results of long-term survival analysis using Fine and Gray's subdistribution hazard model showed no significant difference of the survival rate of the transplant kidney according to DRBWR or DRBSR. Conclusion Donor–recipient size mismatch in pediatric KT is not an important factor in determining the long-term prognosis of transplant kidneys.

#1668 The 60:40 conundrum: are women with CKD discriminated against after referral to a nephrology clinic?

Abstract Background and Aims The representation of women in kidney medicine clinical trials has diffused the belief that women are discriminated although epidemiological data suggest that chronic kidney disease (CKD) is more prevalent among females than males. We aimed to test whether sex distribution varies at nephrology referral, inclusion in a clinical study or at the starting of dialysis. Method This was a retrospective, monocentric study conducted in a large non-university hospital in central France. We exploited data from patients included in the PRO-RE-RE-PRO study on the effect of diet on the progression of CKD. We evaluated patients’ characteristics and gender at the time of the first consultation in the Unit for the Care of Advanced CKD (UIRAV), at the inclusion in the PRO-RE-RE-PRO study and at the beginning of the kidney replacement therapy. Results 866 patients were included in this study as they were referred to the UIRAV, 59% males and 41% females. Female patients were older but less comorbid and were referred at the same eGFR than males. The same proportion of males/females was observed in patients included in the PRO-RE-RE-PRO study. No sex differences were observed at dialysis start. Survival was significantly higher in females. Overall, distribution across sex remained stable over time. Conclusion The main result of this study is the stability of the approximately 35-40% female to 60-65% male ratio from start of follow-up in all subsets of cases: patients referred to the unit dedicated to advanced CKD, patients recruited in the observational study, patients not included, or who refused to participate, patients on follow-up at the completion of the database. Furthermore, the same distribution is observed in dialysis patients, from dialysis start to the most recent update. Our data suggest that if a gender-selection bias exists in nephrology, it should be sought before the first nephrology referral. However, further studies are needed to ensure health equity.

#1800 Cascade filtration in severe pulmonary-kidney syndrome: an one-center experience

Abstract Background and Aims In some forms of rapidly progressive glomerulonephritis (RPGN), the effect of plasma exchange (PE) is not well understood. Cascade filtration (CF) differs from standard PE in that it uses a double filter system, where the first filter is used to separate plasma from whole blood and the second filter is used to filter high-molecular weight substances. In this study, we investigated the efficacy and safety of CF in patients with ANCA-associated vasculitis (AAV) and Goodpasture's syndrome (GPS). Method During one year we included 18 patients with RPGN whose received CF in the study. The eligibility criteria was eGFR ≤15 ml/min/1.73 m2 and/or diffuse alveolar hemorrhage (DAH), presence of antineutrophilic antibodies or anti-GBM-antibodies. CF was performed on a Plasauto Sigma using a Plasmaflo OP-05W plasma separator and a Cascadeflo EC-30W separator with a fresh frozen plasma or 25% albumin solution. All patients received immunosuppressive therapy with steroids and cyclophosphamide, one patient with AAV received rituximab due to anemia and thromobocytopenia. All data were obtained from one hospitalization with the median of 43 days. Results Eight patients with AAV and three patients with GPS met the eligibility criteria. The median age of the patients in the AAV group was 59.8 (48; 66) years, with a female to male ratio of 1:1. All patients had evidence of systemic disease: seven patients had lung damage, including DAH, two patients had arthralgia, one had purpura and one had severe sinonasal involvement. The median creatinine level was 588 µmol/l (382; 1352), dialysis was initiated in 6 patients, and the median Birmingham Vasculitis Activity Score (BVAS) was 17 (15; 20). After three procedures of CF, all patients showed positive changes on CT scan, and dialysis was stopped in three patients. The immunological response to CF was observed quite rapidly in seven patients, with decreasing ANCA titer after three exchanges and decreasing antibody levels after six exchanges in one patient. There was a significant decrease in inflammatory markers, median C-reactive protein at baseline 179 (147; 226) decreased to 23 (2.8; 30.9) mg/l (p = 0.041). The CF was well tolerated with no significant adverse events. One patient receiving rituximab died after 4 months due to a severe COVID 19 infection. Three patients with GPS, one male 23 years old and two females 56 and 60 years old, also received CF. Creatinine concentrations at baseline were 1285, 1299 and 661 µmol/l, BVAS scores were 18, 20 and 15, respectively. After three procedures of CF, there was an immunological response: decrease in antibody levels from 121 U/ml to 15 U/ml, from 88.2 to 18.4 U/ml, from > 200.0 to 85.4 U/ml, CRP from 252 to 0.7 mg/l, from 120 to 5 mg/l, from 81.9 to 12.58 mg/l. There were no deaths and all three patients remained on dialysis. Conclusion CF was an effective and well tolerated method of treating severe AAV and GPS in addition to immunosuppressive treatment. Possibly due to the different filtration principle and the absence of donor plasma, we did not observe any infection-related adverse events and a lower number of procedures of CF was required compared to standard plasma exchanges. Further larger studies are needed to evaluate the benefits and safety of CF in combination with immunosuppressive treatment in RPGN patients.

TRENDS IN TOTAL ANKLE ARTHROPLASTY IN SCOTLAND

IntroductionTotal ankle replacement (TAR) is performed for post-traumatic arthritis, inflammatory arthropathy, osteoarthritis and other indications. The Scottish Arthroplasty Project (SAP) began collection of data on TAR in 1997. In this study, using data from the SAP, we look at trends in the use and outcomes of TAR in Scotland.MethodsWe identified 499 patients from the SAP who underwent TAR between 1997 and 2015 with imaging available on the National Picture Archiving and Communication System (PACS). We identified, and looked at trends in, implant type over the following time periods: 1998–2005; 2006–2010 and 2011–2015. Age, gender, indication and outcomes for each time period were examined and also trends with implant type over time.ResultsThere were 499 primary TAR procedures with an overall incidence of 0.5/105 population per year. Eight different implants were identified with significant changes in the numbers of each type used over time. The peak incidence of TAR was in the 6th decade. The mean age of patients undergoing TAR from 59 years in 1997–2005, to 65 years in 2011–15 (p< 0.0001). The percentage of patients with inflammatory arthropathy was 52% in 1997–2005, compared with 10% in 2011–2015. Subsequent arthrodesis and infection rates appeared to be higher during the first time period. The female to male ratio also changed over time. The incidence of TAR increased overall during the study period (r= 0.9, p=< 0.0001). This may be due to a broadening range of indications and patient selection criteria, in turn due to increased surgeon experience and the evolution of implant design.ConclusionThis study examines a large number of TARs from an established arthroplasty registry. The rate of TAR has increased significantly in Scotland from 1997 to 2015. Indication and patient age has changed over time and this could potentially impact outcomes after ankle replacement.

Ratio-dependent competitions between a Wolbachia-uninfected bisexual strain and Wolbachia-infected thelytokous strain of the egg parasitoid, Trichogramma dendrolimi Matsumura (Hymenoptera: Trichogrammatidae)

BackgroundWolbachia-infected thelytokous Trichogramma wasps have been considered as potential effective biocontrol agents against lepidopteran pests in agriculture and forests. However, intra-specific competition may arise when Wolbachia-infected thelytokous Trichogramma coexist with their uninfected bisexual counterparts in fields or during mass-rearing procedures. This competition could potentially impact the efficacy of Trichogramma females in biological control programs.ResultsThis study examined the parasitic capacities of bisexual (TdB) and Wolbachia-infected thelytokous (TdT) strains of Trichogramma dendrolimi as influenced by host density (ranging from 5 to 70 host eggs) and wasp density (two, four, and six females per arena). The experiments involved inter-strain competition between TdB and TdT strains (Inter-Td) as well as intra-strain competition within the TdT (Intra-TdT) or TdB (Intra-TdB) strains. Results revealed that females in the Inter-Td group exhibited a higher attack rate compared to those in the Intra-TdT and Intra-TdB groups, irrespective of wasp density. Specifically, when six females were present, the Inter-Td group showed significantly shorter host handling times than the Intra-TdT group. Within intra-strain cohorts, TdT females displayed a lower attack rate than TdB females when four or six females were present, and longer host handling times when six females were present. Mutual interference between individuals was not affected by competition types. Females of the Inter-Td group exhibited a higher probability of superparasitism than those of the Intra-TdB group or Inter-Td group. When both strains coexisted, the proportion of TdT offspring with six females was higher than that with two females or four females. Male ratios of bisexual offspring in Inter-Td groups were higher than those in Intra-TdB groups. The male ratio of bisexual offspring in the Inter-Td group increased with wasp density.ConclusionsOur study highlights the negative impact of Wolbachia on parasitic capacity of Trichogramma females, increasing the likelihood of superparasitism. The coexistence of both strains enhances total parasitic efficacy, albeit resulting in a higher proportion of male offspring compared to scenarios with only uninfected females. The results will provide the reference for the usage of Wolbachia-infected thelytokous strain of T. dendrolimi in augmentative biological control programs.

Personalized Management of Malignant and Non-Malignant Ectopic Mediastinal Thyroid: A Proposed 10-Item Algorithm Approach.

We aimed to analyze the management of the ectopic mediastinal thyroid (EMT) with respect to EMT-related cancer and non-malignant findings related to the pathological report, clinical presentation, imaging traits, endocrine profile, connective tissue to the cervical (eutopic) thyroid gland, biopsy or fine needle aspiration (FNA) results, surgical techniques and post-operatory outcome. This was a comprehensive review based on revising any type of freely PubMed-accessible English, full-length original papers including the keywords "ectopic thyroid" and "mediastinum" from inception until March 2024. We included 89 original articles that specified EMTs data. We classified them into four main groups: (I) studies/case series (n = 10; N = 36 EMT patients); (II) malignant EMTs (N = 22 subjects; except for one newborn with immature teratoma in the EMT, only adults were reported; mean age of 62.94 years; ranges: 34 to 90 years; female to male ratio of 0.9). Histological analysis in adults showed the following: papillary (N = 11/21); follicular variant of the papillary type (N = 2/21); Hürthle cell thyroid follicular malignancy (N = 1/21); poorly differentiated (N = 1/21); anaplastic (N = 2/21); medullary (N = 1/21); lymphoma (N = 2/21); and MALT (mucosa-associated lymphoid tissue) (N = 1/21); (III) benign EMTs with no thyroid anomalies (N = 37 subjects; mean age of 56.32 years; ranges: 30 to 80 years; female to male ratio of 1.8); (IV) benign EMTs with thyroid anomalies (N = 23; female to male ratio of 5.6; average age of 52.1 years). This panel involved clinical/subclinical hypothyroidism (iatrogenic, congenital, thyroiditis-induced, and transitory type upon EMT removal); thyrotoxicosis (including autonomous activity in EMTs that suppressed eutopic gland); autoimmune thyroiditis/Graves's disease; nodules/multinodular goiter and cancer in eutopic thyroid or prior thyroidectomy (before EMT detection). We propose a 10-item algorithm that might help navigate through the EMT domain. To conclude, across this focused-sample analysis (to our knowledge, the largest of its kind) of EMTs, the EMT clinical index of suspicion remains low; a higher rate of cancer is reported than prior data (18.8%), incident imagery-based detection was found in 10-14% of the EMTs; surgery offered an overall good outcome. A wide range of imagery, biopsy/FNA and surgical procedures is part of an otherwise complex personalized management.

Clinical and laboratory profiles of systemic lupus erythematosus patients in a new rheumatology clinic in southwestern Nigeria.

The aims were to study the sociodemographic characteristics of patients presenting to the clinic and to study the clinical and serological pattern of systemic lupus erythematosus (SLE) in a new rheumatology clinic of a predominantly Yoruba population. This was a retrospective, cross-sectional study conducted over 7 years (January 2017 - December 2023). Patients who satisfied the 1997 American College of Rheumatology (ACR) and/or the 2012 Systemic Lupus International Collaborating Clinics (SLICC) classification criteria were enrolled using their medical records. Patients with overlap syndromes and other inflammatory or noninflammatory rheumatic diseases were excluded from the study. Their sociodemographic, clinical, laboratory, and treatment data were retrieved from their medical records and analysed using IBM SPSS version 23.0 software. A total of 65 patients were diagnosed with SLE with a frequency of 15.8%. The mean age ±SD of the patients at presentation was 33.85 years ±11.01 and the female to male ratio was 9.8 : 1. The median (IQR) duration of symptoms at presentation was 7.0 months (3-24). The common clinical presentations included synovitis (86.2%), acute cutaneous rash (53.8%), oral ulcers (52.3%), nonscarring alopecia (50.8%), and serositis (47.7%). Proteinuria was seen in 37.7% of the patients and the predominant renal histopathological feature was Class IV. Antinuclear antibody was 100% positive with 50.94% of the patients having a titre of 1 : 5,120 and above. Anti-double-stranded deoxyribonucleic acid and anti-Smith antibodies each had 50% prevalence. Dyslipidaemia was found in 76.7% of the patients. The study's findings are largely consistent with similar studies done in Africa. Further prospective multi-centred studies are needed to further determine the epidemiological characteristics of the disease in Nigeria with a multi-ethnic population.

Effects of Prey Switching at Different Stages on Life Parameters of Neoseiulus bicaudus

The phenomenon of prey switching is prevalent in the natural world and represents a strategic adaptation of predators to their environment. Neoseiulus bicaudus, a native predatory mite found in Xinjiang, serves as a natural enemy to numerous small pests. The utilization of Tyrophagus putrescentiae as an alternative prey for the mass breeding of N. bicaudus is employed to fulfill the demands of enhanced breeding efficiency and cost-effectiveness. Following the introduction of mass breed N. bicaudus into the agricultural ecosystem, there was a switching in the prey of N. bicaudus from Ty. putrescentiae to Tetranychus turkestani. The objective of this study was to investigate the impact of prey switching at various stages on N. bicaudus. This study employed the age-stage, two-sex life table to assess the life parameters of N. bicaudus undergoing prey switching at different stages. The results showed that the survival rate of N. bicaudus was significantly decreased, the developmental period was significantly prolonged, the fecundity was improved during prey switching, and the intrinsic rate of increase of N. bicaudus was significantly decreased. The negative effects of prey switching in larva and deutonymph stages were greater than those in protonymph and adult stages. The stage and age of N. bicaudus undergoing prey switching were positively correlated with the male ratio, and negatively correlated with the total preoviposition period and the mean generation time. The comprehension of prey switching effects on N. bicaudus can enhance our understanding of the predator adaptation to environmental changes and contribute to the artificial rearing and application of natural enemy.

Sex Ratio of Seven Gill Eels Based on System Dynamics and Dynamic Generalisation Models

This paper provides an in-depth study of the ecological impacts of changing sex ratios in the lampreys, an ancient species known as a living fossil, through mathematical modeling. First, a dynamic model was constructed to simulate the response of the sex ratio of the lampreys to food availability and to predict subsequent changes in predator populations within the ecosystem. The model also considered reproductive success to assess broader ecological impacts. The results suggest that changes in lampreys sex ratio can significantly affect ecosystems in many ways. However, risks such as overfishing, environmental stress and predation emerged as clear disadvantages. Further exploration through more advanced dynamic modeling confirmed the stabilizing effect of higher male ratios on the ecosystem. The study also ventured into competition modeling, revealing that lamprey populations may inadvertently favor other species, such as parasites. Taken together, the mathematical modeling in this study provides insights into the ecological role of lampreys and is intended to inform conservation efforts and optimize the ecological use of lampreys.

Insights into systemic lupus erythematosus: a retrospective observational study of clinical features, autoantibodies, and gender-related differences.

This study aims to analyze the clinical and immunologic features of SLE in Jordan, while also investigating the impact of age and gender on disease presentation. The study included 275 patients diagnosed with SLE. Data were collected through meticulous patient interviews and thorough examination of patient hospital records. The cohort exhibited a mean age of 36.8 ± 12.9years, with an average disease duration of 7.0 ± 7.8years. The mean age at diagnosis was 29.9 ± 12.1years, and the female to male ratio was 7.8:1. The most frequently observed symptoms were arthralgia (90.2%), fatigue (80.7%), hematologic manifestations (62%), photosensitivity (60.7%), Raynaud's phenomenon (53.5%), and malar rash (50.9%). The frequencies of various autoantibodies were as follows: ANA (96.7%), anti-dsDNA (39.6%), anti-SSA/Ro (32.8%), anti-Sm (21.8%), anti-U1-RNP (20.6%), and anti-SSB/La (15.5%). Male patients tended to receive a diagnosis at a younger age and exhibited a higher likelihood of experiencing severe manifestations compared to females. Additionally, juvenile onset patients demonstrated an increased likelihood of fever, photosensitivity, myositis, and anti-dsDNA autoantibodies, while adult onset patients were more predisposed to having anti-Ro, anti-La, and RF autoantibodies. This study reveals that the most prevalent manifestations of SLE in the Jordanian cohort encompassed arthralgia, fatigue, and hematologic manifestations. The prevalence of alopecia and Raynaud's phenomenon exceeded that observed in other published cohorts, while arthritis and discoid rash were less frequently encountered. The study highlights that males are more susceptible to developing severe manifestations of SLE compared to females.

Epidemiology and Risk Factors for Revision Total Knee Arthroplasty in Chinese Patients: A Retrospective Study in Changchun, Jilin Province, China.

BACKGROUND Over the past decades, total knee arthroplasty (TKA) in China has increased substantially. Owing to a lack of a joint registry, there is restricted information concerning the epidemiology of TKA failures in China. We aimed to (1) investigate the etiology of TKA failures in a cohort of Chinese patients and (2) determine the related demographic and anthropometric risk factors in Jilin, China, to have a look at the actual situation. MATERIAL AND METHODS A total of 1927 primary and 109 revision TKAs performed between April 2014 and May 2022 were analyzed in this retrospective study. Patient demographics and anthropometric measures, the interval from primary TKA to revision procedures, and the mechanisms for primary TKA failure were evaluated. A chi-square test, unpaired t test, and multivariate logistic regression were used to investigate the relationships between different factors and TKA failures. RESULTS The leading failure mechanism was infection (53.3%), followed by aseptic loosening (21.5%), stiffness (15.0%), instability (3.7%), malposition (2.8%), periprosthetic fractures (2.8%), and extensor mechanism disruption (0.9%). Infection (59.7%) was the main reason for early revision. Aseptic loosening (43.3%) was the leading cause of late revision. The male ratio in infection patients was higher (35.1% vs 20.6%). The smoking rate in patients with revision and infection was higher (18.9%, 23.9% vs 7%) than in primary patients. There was no difference in BMI between groups. CONCLUSIONS The leading cause of revision TKA in Jilin, China, was infection, followed by aseptic loosening and stiffness. Sex and smoking history were associated with TKA failures in this region.

SURVEY OF ELEVATED BLOOD PRESSURE IN CHILDREN

Background: Hypertension is one of the leading risk factors for death, one of the main risks of cardiovascular disease. Clinical characteristics of hypertension are diverse, the early detection of symptoms of hypertension contributes significantly to early diagnosis and treatment. In Can Tho, there is little research on hypertension in children. Objectives: Describe the clinical and subclinical characteristics of hypertensive children being treated at the Cardiology Department, Can Tho Children’s Hospital. Materials and methods: Analytical descriptive cross-sectional study on 96 pediatric patients diagnosed with hypertension at Can Tho Pediatrics Hospital. Research subjects: Pediatric patients (<16 years old) being treated at the department who are expected to have hypertension over a period of time. Sample selection criteria: Pediatric patients are expected to have hypertension determined according to the standards of the new Guidelines in Clinical Practice of the American Academy of Pediatrics (AAP) 2017. Exclusion criteria: Family members do not agree to allow the patient to participate in the study. Children are not appropriate for measuring BP due tocongenital anomalies: Ventricular septal defect, Atrial septal defect, Patent ductus arteriosus, Tetralogy of Fallot. Results: The common age group is under 13 years old (60.4%). The male and female gender ratio is approximately 2.1/1. The stage 2 hypertension classification is the most common (49.8%). The rate of neurological, gastrointestinal and cardiovascular symptoms was 59.4%, respectively; 19.8%; 24%. And there is no association between gastrointestinal, cardiovascular clinical symptoms and the grade of hypertension (p>0.05). Hyperlipidemia, HbA1C in children with hypertension accounted for a high rate of 47.1% and 50%. While in BUN disorder, proteinuria accounted for a low rate of 5.3% and 26.3%. No abnormalities were noted on renal Doppler ultrasound. The rate of abnormal results on echocardiography, chest X-ray and ECG was 53.3%; 23.3%;13.7% respectively.

Effect of moyamoya disease on the basilar artery and adjacent arteries on CTA

BackgroundComputed tomographic angiography (CTA) is rarely used to explore the effect of moyamoya disease (MMD) on the basilar artery (BA) and its adjacent arteries. MethodsParticipants were divided into a control group and an MMD group. The relevant parameters were measured. Statistical analyses included the t-test, chi-squared test, and linear regression analysis. ResultsIn the control group of 100 healthy people, the average age was 54.51 ± 13.40 years, and the ratio of males to females was 0.89:1. In the MMD group of 100 patients, the average age was 53.95 ± 11.31 years, and the ratio of males to females was 1.13:1. In the MMD group, the CTA score of the anterior circulation of the bilateral hemispheres was 7.57 ± 2.36. According to the statistical analyses, (1) in the control group, the BA apex tended to lean to the right in healthy participants; (2) in the MMD group, the BA was closer to the midline, and the angle between the BA and anterior inferior cerebellar artery was reduced, indicating that the BA was relatively elevated; (3) in the MMD group, the diameters of the BA, PCA and vertebral artery were larger than those in the control group; and (4) MMD patients with posterior cerebral atery (PCA) involvement had higher CTA scores of the anterior circulation. ConclusionsMMD can cause the BA to move toward the midline and upward and enlarge major vessels of the posterior circulation. The PCA tends to be involved in MMD patients with higher CTA scores in the anterior circulation.

Lower body bone fractures have high mortality rates and poor prognosis in the patients with hemodialysis.

The objective of the current study was to investigate the association between lower body bone fractures occurring during maintenance hemodialysis and prognosis. This study included 151 hemodialysis patients at the dialysis center of our hospital as of December 2017, and data were systematically gathered from medical records over a period of 5 years, concluding in December 2022. Fourteen patients, 3.0 per 100 person-years, in 151 hemodialysis patients suffered from lower body bone fractures. The ratio of males was significantly lower, and age was significantly higher in the lower body bone fracture group than in the no lower body bone fracture group. Duration of hemodialysis prior to entry into this study was significantly shorter in the lower body bone fracture group than in the no lower body bone fracture group. Serum albumin was significantly lower and alkaline phosphatase was significantly higher in the lower body bone fracture group than in the no lower body bone fracture group. Mortality rate was significantly higher in the lower body bone fracture group (85.7%) compared to no lower body bone fracture group (28.5%) (p = 0.01). Kaplan-Meier survival curves for mortality showed that lower body bone fracture group had poor prognosis compared to no lower body bone fracture group. Multivariable-adjusted odds ratio for mortality were significantly higher for cases with lower body bone fractures. Lower body bone fractures have high mortality rates and poor prognosis in the patients with hemodialysis.

THE NATIONAL PROSTHETIC HIP DISLOCATION (PHD) STUDY

Total Hip Arthroplasty (THA) and Hip Hemiarthroplasties (HA) are successful, cost-effective procedures that improve quality of life. Dislocation is a well recognised complication with a significant health and economic burden. We aim to establish the current management practices across the United Kingdom (UK) for Prosthetic Hip Dislocations (PHD). Our definition of a PHD includes; THA, HA and revision THA.This national study builds on our regional pilot study and records one of the largest datasets of Prosthetic Hip Dislocation management within the UK.A trainee-led collaborative; the North West Orthopaedic Research Collaborative (NWORC). Conducted a retrospective audit, registered as Quality Improvement (QI) projects, collected data from 38 hospital trusts across the UK.Data was collected on patient-related factors, inpatient management, and outpatient follow up of each PHD episode between January and July 2019. Primary outcome measured definitive management, in the form of revision surgery or the consideration for this through a referral pathway.A total of 673 (THA 504, Revision THA 141, HA 28) patients were included with a total of 740 dislocation episodes. Mean age was 75.6 years with female to male ratio 2:1. The majority of PHDs were a result of a low energy mechanism (98.7%) and presented over 6 months post index procedure (80.5%). Over half (53.8%) attended with a first or second time dislocation. Only 29.9% patients received onward revision referral; whereas 70.1% followed diverse management patterns, including local non-arthroplasty and primary arthroplasty surgeon follow-ups. Revision THAs had higher rates of referral for revision (p<0.001) compared to primary THA and HA dislocations.A high number of PHDs present across the UK, with under a third receiving definitive management plans. This variation increases the economical burden to the National Health Service, highlighting the need for national guidance to manage these complex patients.

Characteristics and outcomes of patients developing pulmonary hypertension associated with proteasome inhibitors.

Pulmonary arterial hypertension (PAH) has been described in patients treated with proteasome inhibitors (PIs). Our objective was to evaluate the association between PIs and PAH. Characteristics of incident PAH cases previously treated with carfilzomib or bortezomib were analysed from the French pulmonary hypertension registry and the VIGIAPATH programme from 2004 to 2023, concurrently with a pharmacovigilance disproportionality analysis using the World Health Organization (WHO) global database (VigiBase) and a meta-analysis of randomised controlled trials. 11 incident cases of PI-associated PAH were identified (six with carfilzomib and five with bortezomib) with a female:male ratio of 2.7:1, a median age of 61 years, and a median delay between PI first exposure and PAH of 6 months. Four patients died (two from right heart failure, one from respiratory distress and one from an unknown cause). At diagnosis, six were in New York Heart Association Functional Class III/IV with severe haemodynamic impairment (median mean pulmonary arterial pressure 39 mmHg, cardiac index 2.45 L·min-1·m-2 and pulmonary vascular resistance 7.2 WU). In the WHO pharmacovigilance database, 169 cases of PH associated with PI were reported since 2013 with significant signals of disproportionate reporting (SDR) for carfilzomib, regardless of the definition of cases or control group. However, SDR for bortezomib were inconsistent. The systematic review identified 17 clinical trials, and carfilzomib was associated with a significantly higher risk of dyspnoea, severe dyspnoea and PH compared with bortezomib. PIs may induce PAH in patients undergoing treatment, with carfilzomib emitting a stronger signal than bortezomib, and these patients should be monitored closely.

ASSESSMENT OF HYPERTENSIVE PATIENTS’ COMPLEX METABOLIC STATUS IN THE NORTHEASTERN REGION OF HUNGARY USING DATA MINING METHODS

Objective: Previously, the metabolic status of Central and Eastern European hypertensive adult patients has not been thoroughly explored. Therefore, we aimed to identify the prevalence of hypertension and its associated metabolic abnormalities in a relatively large adult population using data mining methods. Design and method: We analyzed the data of adults who visited the University of Debrecen Clinical Center’s hospital (n = 937,249) by evaluating a period of 20 years (2001-2021). Results: We identified a total of 292,561 adults with hypertension (male/female: 45.4/54.6%), with a 31.2% calculated prevalence of hypertension in the whole study population and a higher prevalence in males (33%) compared to females (29.9%). We found an increasing prevalence in consecutive age groups both in males and females up to the age of 80. The ratio of males with hypertension was higher from 18 to 65 years of age. Markedly higher body mass index (BMI) values were found in hypertensive patients as compared to non-hypertensives (29.5±6.3 vs. 26.57±5.6 kg/m2, p<0.001). A significantly higher triglyceride level was found in hypertensive adults compared to non-hypertensives (1.46 (1.06–2.07) vs. 1.19 (0.82–1.73 mmol/L, p<0.001). We could not find significant differences in total cholesterol and LDL-C levels in the entire patient population (5.1±1.2 vs. 5.0±1.2 mmol/L and 3.1±0.99 vs. 3.1±1.0 mmol/L, respectively). Significantly higher serum glucose levels (5.8 (5.2–6.9) vs. 4.7 (4.6–5.8) mmol/L, p<0.001) were found in subjects with hypertension. Significantly higher urea and creatinine levels were found in hypertensive patients compared to normotensives (5.78 (4.6–7.5) vs. 4.6 (3.7–5.7) mmol/L, p<0.001 and 76 (64–92) vs. 69 (59–81) μmol/L, p<0.001, respectively). Furthermore, we also assessed the rate of significant concomitant diseases in our hypertensive population. Conclusions: The results proved that data mining is an excellent yet not-too-widespread method used to define prevalence in large patient cohorts. This novel way of statistical analysis could be beneficial not only for regional clinical practice but nationwide strategies as well.

Monogamous hybridization of Nile tilapia (Oreochromis niloticus) with Mozambique tilapia (O. mossambicus) results in unprecedented all-female F1 hybrid

Tilapiine breeding success is season-dependent, with very rare exceptions. The female (f) to male (m) ratio differences showed significant variations in fruitful breeding. Furthermore, the female-to-male ratio in any hybridization protocol involving reciprocal crosses may be the most influential factor in determining breeding seasonality. The innate genetic traits of tilapia, a prominent contributor to global aquaculture production, enable them to easily adapt to a wide range of aquatic environments, rendering them suitable for domestication. The study aimed to determine the breeding timeframe of Nile tilapia (Oreochromis niloticus, N) through interspecific monogamous/two-parent reciprocal crossing with Mozambique tilapia (O. mossambicus, M). Considering preselected genotypic characteristics by PrlLK microsatellite marker, different combinations of hybrid reciprocal crosses were performed in breeding hapa (3 × 3 × 3 cubic feet) inside an indoor plastered cemented tank and then in an outdoor earthen pond facility. Total 11 parental pairs were attempted to propagate inside a cemented tank with (9 pairs) and without (2 pairs) hapa during early April to mid-June. Unfortunately, the trials failed to produce any successful breeding within the schedule. Among those 11 pairs, 6 pairs were Nf × Mm and 5 pairs were Mf × Nm cross. In the earthen pond inside hapa, a total of 18 pairs were attempted where seven breeding successes were reported without demonstrating any dependency for hybridizations over cross types or genotypes and for individuals over sex or species. Successful breeding were reported from the month of May to November. There were few overlapping months of successful breeding for different grouping categories. During the successful breeding period, there were no successful outcomes in both August and October. An inadvertent all-female F1 generation was observed for Mf × Nm crosses, while the reciprocal cross Nf × Mm produced an F1 generation with a nearly 1:1 female to male ratio. The F1 sex ratios exhibited a significant reliance on parental genotypic combinations (p = 5.4e-11). The success stories from different cross combinations would help to frame the breeding protocol for future research. More precisely, for arranging a breeding schedule in freshwater earthen ponds inside hapa for a monogamous/two-parent hybrid cross the study light a close insight.