Obesity increases the risk of cardiovascular conditions including heart failure. This makes it important to have an accurate method to evaluate left ventricular ejection fraction (LVEF) for early diagnosis and treatment. While 2D echocardiogram is easily accessible, increased BMI affects image quality and subsequently the accuracy of LVEF. In this study, we compared the correlation between LVEF derived from a 2D echocardiogram and a gated cardiac blood pool scan (GCBPS) in obese patients who underwent both imaging modalities. We performed a retrospective single-centre cohort study of obese patients (BMI 30 kg/m 2 and above) who had both 2D echocardiogram and GCBPS within 6 months of either investigation at a large tertiary centre from January 2023 through May 2024. Baseline characteristics, including age, gender, comorbidities and indications for both investigations, were included. A total of 30 patients (mean age 65.11 ± 16.79) were included. There is an overall strong positive Pearson correlation between LVEF derived from echocardiogram and GCBPS ( r = 0.69, P < 0.001). However, there is a nonsignificant, weak, positive Pearson correlation between LVEF derived from echocardiogram and GCBPS in the female sex ( r = 0.28, P = 0.370). The number of comorbidities, male sex, age, BMI, order, or days between scans does not affect the LVEF obtained. There is a good correlation between LVEF derived from either echocardiogram or GCBPS in the male sex with an insignificant weak correlation in the female sex. Assessment of LVEF in obese female patients would benefit from using a GCBPS instead of an echocardiogram.

The effect of inhaler prescription and comorbidities on the prognosis of COPD in never-smokers: A nationwide population-based study.

Differential safety profiles of disease-modifying therapies in MS: Age- and sex-based analysis from a real-world cohort.

The impact of the BCIS CHIP score on the prognosis of ischemic acute heart failure.

Age-stratified outcomes after laparoscopic inguinal hernia repair in children: A large single-center cohort study.

Mansonella streptocerca is a species of neglected skin-dwelling filarial nematode parasite with scarce epidemiologic data from Central Africa. We conducted a cross-sectional survey of 1,007 adults from 51 rural and semiurban communities in Gabon to update prevalence estimates and identify risk factors. Molecular analyses by quantitative PCR detected filarial DNA in 18.3% of skin snips; M. streptocerca predominated (14.2%), and Onchocerca volvulus (3.4%) occurred focally in a single rural area. Blood-dwelling parasite species such as Loa loa, M. perstans, and Mansonella sp. "DEUX" were rarely detected. M. streptocerca infection was 4 times more frequent in rural areas than in semiurban areas and independently associated with male sex, urticaria, and poor housing conditions. Wolbachia DNA occurred in 28% of M. streptocerca-positive samples, suggesting endosymbiosis. Our findings reveal a substantial but overlooked burden of M. streptocerca nematodes in Gabon and emphasize the need for integrated surveillance of skin-dwelling filarial infections in Central Africa.

Acute Kidney Injury (AKI) increases morbidity and mortality risk, yet data in pediatric trauma are limited. This study evaluated the incidence of Kidney Disease: Improving Global Outcomes (KDIGO) stage 3 AKI, kidney replacement therapy (KRT) use, and associated risk factors in pediatric trauma patients. Pediatric patients (< 18years) in the Trauma Quality Improvement Program (TQIP) database from 2017-2023 were analyzed for stage 3 AKI. Multivariable logistic regression (MVLR) identified associations between AKI and adverse outcomes, adjusting for confounders. Serious injury was defined as an abbreviated injury scale (AIS) ≥ 3 per body region. Among 867,467 pediatric trauma cases, 510 developed stage 3 AKI. Compared to children without stage 3 AKI, affected children had higher median composite injury severity scores (4 versus 26, p < 0.001) and lower survival (98% versus 69%, p < 0.001). In the MVLR model, older children, male sex (OR 1.20, 95%CI: 0.97-1.49), serious injury to the head/neck (3.48, 2.84-4.28), thorax (2.50, 2.00-3.11), abdomen (5.90, 4.79-7.28), extremities (2.26, 1.84-2.79), and skin (3.16, 2.14-4.68), in-hospital cardiac arrest (8.18, 6.24-10.72), pulmonary embolism (3.88, 1.97-7.66), sepsis (36.32, 23.83-55.37), ventilator-associated pneumonia (3.10, 1.96-4.91), acute respiratory distress syndrome (1.73, 1.03-2.89), and extracorporeal support (9.34, 5.51-15.85) were associated with stage 3 AKI. Patients with urologic injuries had higher rates of stage 3 AKI (0.6% vs. 0.046%, p = 0.0001). KRT was used in 20% of stage 3 AKI cases. Stage 3 AKI was rare in pediatric trauma but strongly linked to abdominal, head/neck, and urologic injuries. Mortality was markedly increased when stage 3 AKI occurred.

The Paris System for Urine Cytology: Prospective Assessment of Reproducibility, Diagnostic Accuracy, and Malignancy Risk.

Postoperative complications may affect the long-term outcomes after colorectal cancer (CRC) surgery. This multicenter study compared prognostic factors for overall survival (OS) in younger (≤ 74 years) and older (≥ 75 years) patients after curative resection for CRC, focusing on the 1-year and post-1-year outcomes. We analyzed data from 1582 patients who underwent curative surgery for CRC at six hospitals between April 2016 and December 2019. Kaplan-Meier and Cox models were used to identify the risk factors for complications and survival. Older patients had a significantly worse overall survival (OS) and survival beyond the 1-year landmark. Postoperative complications were associated with increased 1-year mortality in both age groups. In younger patients, survival beyond 1 year was associated with a positive N status and a low BMI. In contrast, in older patients, postoperative complications remained associated with survival beyond the 1-year landmark, along with a male sex, positive N status, and poor ASA-PS. The prolonged impact of complications on survival in older patients with CRC underscores the need for age-specific surgical strategies and proactive complication management.

E-cigarette and cannabis use and susceptibility among secondary school students in Thailand.

What factors are associated with work after cardiothoracic transplant? A systematic review.

In a survey of patients with end stage kidney disease treated (ESKD), improvement in sleep was one of the most desired outcomes of an exercise program. In participants with ESKD enrolled in an exercise study, our objectives included: 1) assess sleep quality using objective and subjective measures, 2) determine variables associated with poor sleep and 3) determine correlation between the objective and subjective measures. In this cross-sectional study, adult patients with ESKD at 4 academic Canadian hospitals completed objective and subjective sleep using 2 weeks of Fitbit data and the Pittsburgh Sleep Quality Index (PSQI) respectively. Poor sleep was defined as: 1) total sleep <360min or sleep efficiency <80% with the Fitbit or 2) PSQI >5. Percentage of participants with poor sleep was calculated; variables associated with poor sleep were determined using logistic regression. Correlations between the Fitbit and PSQI for select variables was determined using Pearson correlation coefficients. Ninety-one of 131 patients screened were included in the final analysis. Participants had a mean age of 62.0 (±13.4) years, 48% female. Sixty-eight percent and 66% of the population were considered poor sleepers by Fitbit and PSQI respectively. Male sex was associated with poor sleep with the Fitbit; BMI was associated with poor sleep by PSQI. The correlation between sleep efficiency and hours of true sleep from the Fitbit and PSQI was 0.06 (p=0.61) and 0.44 (p<0.0001) respectively. Most patients with ESKD experienced poor sleep. Consistent with other populations, the objective and subjective measures of sleep were weakly correlated suggesting instrument choice should align with the specific outcome of interest. Further research is required in the ESKD population is required.

Graft failure after anterior cruciate ligament (ACL) reconstruction (ACLR) may be influenced by both extrinsic exposure and intrinsic patient susceptibility. A contralateral ACL rupture could reflect an inherent predisposition to ligament injury. To determine whether a history of bilateral native ACL ruptures increases the risk of graft failure after primary ACLR. Cohort study; Level of evidence, 2. A total of 7718 consecutive patients who underwent primary ACLR by a single surgeon (2003-2022) were included. Graft failure, defined as a clinically and magnetic resonance imaging-confirmed rupture, was compared between patients with bilateral versus unilateral native ACL ruptures. Multivariable logistic regression identified independent predictors, including age, sex, Tegner score, sport type, and a history of bilateral rupture. The cohort included 6327 patients with isolated native ACL rupture and 1391 patients with bilateral native ACL rupture. The overall graft failure rate was 6% (461-7718), with a mean follow-up of 135.9 months. Patients with bilateral ACL ruptures had a higher failure rate (9.3%) than those with unilateral injuries (5.2%) (P < .0001). Independent predictors included younger age (odds ratio [OR], 0.92 [95% CI, 0.90-0.93]; P < .0001), male sex (OR, 1.46 [95% CI, 1.10-1.96]; P = .0089), higher Tegner score (OR, 1.09 [95% CI, 1-1.19]; P = .043), and bilateral rupture (OR, 1.34 [95% CI, 1.03-1.73]; P = .028). Bilateral native ACL rupture independently increases the risk of graft failure after ACLR. This finding supports its use as a marker of intrinsic vulnerability that may warrant targeted preventive or surgical strategies.

The Diffusion Tensor Imaging along the Perivascular Space (DTI-ALPS) index has been proposed as a non-invasive marker of glymphatic function, but its specific utility in the context of SVD and cognition remains unclear. In 189 patients with mild ischaemic stroke (age 38.8-86.3 years), we computed DTI-ALPS and quantified imaging markers of SVD: enlarged perivascular spaces (PVS), white matter hyperintensities (WMH), and cerebral microbleeds. Cognitive function was evaluated using the Montreal Cognitive Assessment (MoCA). Linear regression models were used to explore the associations between DTI-ALPS, SVD markers and cognition. We found that lower DTI-ALPS values were associated with higher volume of basal ganglia PVS (β = -0.026, 95% CI [-0.052, -0.001]) and with male sex (-0.058, [-0.105, -0.010]). DTI-ALPS was also negatively associated with fractional anisotropy (FA) (-0.062, [-0.084, -0.040]) and mean diffusivity (MD) (-0.056, [-0.092, -0.021]) and positively associated with both neurite density (NDI) (0.033 [0.001,0.065]) and orientation dispersion (ODI) (0.079 [0.061,0.097]) indices. Higher WMH volume predicted lower DTI-ALPS in patients with non-lacunar stroke (-0.079 [-0.118, -0.041]). No associations were observed between DTI-ALPS values and microbleeds or MoCA scores. These findings suggest that, in post-stroke SVD, the DTI-ALPS index may primarily reflect local tissue fluid changes and microstructure damage, rather than serving as a specific, direct indicator of glymphatic function or cognitive impairment. Future research using region-specific and physiologically dynamic imaging approaches may be better suited to capture the glymphatic contributions to stroke and SVD pathology.

Antipsychotic polypharmacy (APP), defined as the concurrent use of two or more antipsychotic agents, remains common in clinical practice despite antipsychotic monotherapy being the recommended standard for schizophrenia treatment. This nationwide cross-sectional survey examined the prevalence and determinants of APP among outpatients with schizophrenia in Japan. Data were collected from 3657 patients across 36 medical institutions between 21 and 25 October 2024. Patients were categorized into antipsychotic monotherapy and APP groups, and demographic and clinical characteristics, including age, sex, medication administration frequency, use of long-acting injectables, clozapine, and concomitant psychotropic medications, were compared. Antipsychotic doses were standardized to chlorpromazine equivalents and analyzed by sex and age group. APP was observed in 40.8% of patients. Multivariable analyses showed that APP was significantly associated with male sex, older age, long-acting injectable use, and concomitant use of antiparkinsonian agents, anxiolytics/hypnotics, and mood stabilizers, whereas clozapine use was inversely associated with APP. Chlorpromazine equivalent doses increased with the number of antipsychotics prescribed, peaking in patients aged 40-59 years and declining thereafter. Second-generation antipsychotics predominated overall, although first-generation antipsychotic use increased with polypharmacy. These findings underscore the importance of careful management of APP, taking sex- and age-related prescribing patterns into consideration.

Early Postoperative Adverse Events Following Multi-Level Posterior Segmental Spinal Instrumentation: A Decade-Spanning Retrospective Analysis.

Prediction of hepatocellular carcinoma (HCC) risk in chronic hepatitis B (CHB) after hepatitis B surface antigen (HBsAg) seroclearance is important for optimizing surveillance strategies. This study aimed to identify independent risk factors of HCC after HBsAg seroclearance and to develop and validate a risk prediction model. A total of 6536 CHB patients who achieved HBsAg seroclearance between January 2006 and June 2025 were retrospectively screened, with 3852 patients meeting the criteria for final analysis. A predictive model was developed via multivariate Cox proportional hazards regression analysis, with discrimination assessed using Harrell's C-index and time-dependent receiver operating characteristic curve area under the curve (AUC). Internal validation of the model was conducted through bootstrap resampling analysis. During 21,711 person-years of follow-up, 128 patients (3.3%) developed HCC (incidence rate: 0.59% per year). Multivariable analysis identified age, male sex, cirrhosis, antiviral therapy (AVT)-induced seroclearance and lower levels of platelets and albumin as independent predictors of HCC. The six independent variables were used for constructing the novel prediction model. Harrell's C-index of the model was 0.766. The novel model has a good predictive ability for HCC risk in the 3-year (AUC = 0.785), 5-year (AUC = 0.775) and 10-year (AUC = 0.830) with similar discriminative performance observed in internal validation. The independent risk factors of HCC occurrence are age ≥ 50 years, male, platelet count≤ 150 × 109/L, albumin level ≤ 44 g/L, with cirrhosis at HBsAg seroclearance and AVT-induced HBsAg seroclearance. Our six-factor model enables risk stratification among patients achieving HBsAg seroclearance and may assist in informing surveillance strategies in clinical practice.

The incidence of early-onset colorectal cancer (EOCRC), defined as colorectal cancer diagnosed before the age of 50 years, has been increasing. The relationship between demographic, birth, and parental characteristics and risk of EOCRC has not been elucidated. This study included 1221 cases born and diagnosed with EOCRC at the age of 0 to 39 years in California during 1988 through 2021 and 61,050 frequency-matched controls based on birth year. Odds ratios (OR) and 95% CIs were estimated using multivariable logistic regression models. Based on multivariable analysis, males had 34% higher risk of EOCRC compared to females (OR=1.34; 95% CI, 1.20-1.51), and Hispanic ethnicity was associated with 43% higher risk of EOCRC (OR for Hispanic versus non-Hispanic White=1.34; 95% CI, 1.20-1.51). Having a foreign-born mother was associated with a lower risk of EOCRC (OR=0.85; 95% CI, 0.73-0.97). Among females, every 500-g increase in birthweight was associated with 10% increase in EOCRC risk (OR=1.10; 95% CI, 1.01-1.21) and having a father aged ≥35 years was associated with higher risk of EOCRC (OR=1.56; 95% CI, 1.08-2.25). No other demographic, birth, and parental characteristic was significantly associated with risk of EOCRC. High birthweight, male sex, Hispanic ethnicity, and older paternal age are potential risk factors for EOCRC. Maternal birthplace, which is associated with diet, smoking patterns, other health-promoting characteristics, may be protective against EOCRC. These factors require future research for validation and evaluation of possible mechanisms.

Early detection of gastric dysplastic lesions and early gastric cancer (EGC) is crucial to enable prompt treatments, such as endoscopic submucosal dissection (ESD). Understanding the distribution and characteristics of these lesions can enhance the efficiency of endoscopic examinations. This study aimed to analyze the locations and characteristics of dysplasia and EGCs in the stomach. Retrospective study reviewing pathologically diagnosed gastric dysplasia and EGCs treated by ESD. Lesions were grouped by location (proximal-cardia, fundus, and body; distal-incisura and antrum) and compared regarding several clinicopathological variables. A predictive model - Search At the Top (SAT) score - was created using three pre-endoscopic variables: male sex (2 points), excessive alcohol consumption (1 point), and smoking (1 point). The score was evaluated for its ability to predict proximal lesions. A total of 215 patients were included (66.5% male; mean age 68 ± 8 years), with 225 lesions analyzed: 50.7% low-grade dysplasia, 30.7% high-grade dysplasia, and 18.6% adenocarcinoma. Most lesions were located in the distal stomach (73.3%) and along the lesser curvature (39.6%).Proximal lesions were more often associated to male sex (P = 0.001), younger age (P = 0.027), alcohol consumption (P = 0.003), and smoking (P = 0.008).The SAT-score showed moderate discriminative performance (area under the curve = 0.674) and identified high-risk patients (score ≥3) with 3.5-fold increased odds of having proximal lesions (odds ratio = 3.459; P < 0.001). Most gastric dysplastic lesions and EGCs were located in the distal stomach and along the lesser curvature. Proximal gastric lesions were more frequent in younger male patients with alcohol and tobacco exposure. These location-specific characteristics can enhance the diagnostic performance of endoscopic screening and surveillance, potentially leading to improved patient outcomes.

Temporal patterns of depressive symptoms and risk of osteoarthritis: A multi-cohort longitudinal analysis.