Male Subgroup Research Articles

BMI trajectories are associated with NAFLD and advanced fibrosis via aging-inflammation mediation

BackgroundAs the global epidemic of obesity fuels metabolic conditions, the burden of nonalcoholic fatty liver disease (NAFLD) will become enormous. Abundant studies revealed the association between high body mass index (BMI) and NAFLD but overlooked the BMI patterns across life stages. We aimed to explore how BMI trajectories over age relate to NAFLD.MethodsSelecting 3212 participants in NHANES 2017–2020, we tracked BMI records at different ages. Using a latent class trajectory model (LCTM), we identified BMI trajectories over age. Multinomial logistic regression assessed their association with NAFLD and advanced fibrosis. Structural equation modeling (SEM) revealed mediation effects.ResultsWe identified 3 BMI trajectories: Steady Progression, Increase to Decrease, and Rapid Ascending. There was no significant difference in NAFLD/advanced fibrosis risk between the increase-to-decrease group and the steady progression group. The Rapid Ascending trajectory significantly correlated with NAFLD (OR = 2.21, 95% CI 1.29–3.77) and advanced fibrosis (OR = 3.04, 95% CI 1.13–8.22). This association was influenced by a chain-mediated process of phenotypic age and C-reactive protein (mediated effect to NAFLD = 0.010, p < 0.01; mediated effect to advanced fibrosis = 0.003, p < 0.05). This mediation on NAFLD was independent of insulin resistance (IR). The association between rapid ascending trajectory and advanced fibrosis was more pronounced among the male subgroup (p for interaction = 0.008).ConclusionThe rapid ascending trajectory of BMI correlates with an increased susceptibility to NAFLD and advanced fibrosis independent of BMI, mediated by aging and inflammation. Our results suggest that long-term maintenance of BMI is pivotal in NAFLD prevention. Aging-inflammation may represent a distinct mechanism of sustained obesity to NAFLD, independent of IR.

Association between serum uric acid, hyperuricemia and low muscle mass in middle-aged and elderly adults: A national health and nutrition examination study.

Recent research suggests that uric acid, as a metabolite with antioxidant properties, may affect muscle function and health. However, the association between serum uric acid (SUA) and low muscle mass remains relatively obscure. This study focuses on the association between SUA and low muscle mass in a middle-aged and elderly population in the United States. Utilizing data from the National Health and Nutrition Examination Survey (NHANES), a total of 12,106 patients aged ≥45 years, possessing complete analytical data, were incorporated. Low muscle mass in our study is defined as indices below 0.789 for males and 0.512 for females, according to the FNIH Biomarkers Consortium. Gender stratified analyses were conducted employing a multivariate weighted logistic regression model. When examining serum uric acid (SUA) levels, the SUA dataset was stratified into deciles, and odds ratios (ORs) were calculated across distinct subgroups of males and females. A restricted cubic spline (RCS) method was employed to investigate the potential nonlinear association between SUA levels and low muscle mass. A series of subgroup analyses stratified by demographic variables and clinical experience were conducted. A total of 2,185 participants (18.05%) were identified with low muscle mass, comprising 1,121 males and 1,064 females. Females with low muscle mass had higher SUA levels and an increased incidence of hyperuricemia compared to those without low muscle mass. In females, a fully adjusted multivariable weighted regression model revealed a positive association between hyperuricemia and low muscle mass (OR, 1.43; 95% CI, 1.06 to 1.92; P = 0.021). No significant association was observed in males. Additionally, RCS curves indicated a J-shaped relationship between increasing SUA levels and the risk of low muscle mass in females, and an inverse J-shaped relationship in males. This study reveals a significant positive correlation between hyperuricemia and the risk of low muscle mass in middle-aged and older women in the United States, whereas the relationship between SUA levels and low muscle mass did not attain statistical significance. In the male cohort, neither SUA levels nor hyperuricemia demonstrated a significant association with low muscle mass.

Comparative Analysis of Long-Standing and Newly Diagnosed Diabetes Mellitus in Patients with Pancreatic Ductal Adenocarcinoma: A Tunisian Multicenter Study.

Diabetes mellitus has emerged as a global public health issue due to its increasing prevalence and the increased risk of developing cancers. Pancreatic cancer is believed to be both a consequence of pre-existing diabetes and a potential cause of new-onset diabetes. This study aims to compare the characteristics of patients with pancreatic ductal adenocarcinoma and newly diagnosed or long-standing diabetes mellitus. A multicentric retrospective study was conducted over 13 years at two university hospitals in Sousse, Tunisia. Included patients had whether a newly diagnosed or a long-standing diabetes mellitus with histologically confirmed pancreatic ductal adenocarcinoma. Statistical analysis using appropriate tests was conducted. The prevalence of diabetes mellitus was 44.6% among three hundred and seven patients with pancreatic cancer. The male-to-female ratio in patients with pancreatic ductal adenocarcinoma was 2.6:1. Patients' mean age was 63.9 years, with the majority being over 50 years old. Most patients had no family history of diabetes and exhibited significant weight loss, low body mass index, and uncontrolled diabetes. The comparison between individuals with newly diagnosed diabetes and those with long-standing diabetes revealed numerous similarities, apart from significant differences in drinking patterns (p = 0.03), tumor size (p = 0.018), and smoking in the subgroup of males (p = 0.044). Patients over 50 with newly diagnosed diabetes mellitus, particularly those who consume alcohol occasionally and men who are not heavy smokers, should undergo further evaluation to identify potential early-stage pancreatic ductal adenocarcinoma.

Dietary Iron Intake and Mental and Behavioral Disorders Due to Use of Tobacco: A UK Biobank Study

Background: Over 1 billion smokers worldwide, one-third of whom have mental and behavioral disorders, exist. However, factors influencing mental and behavioral disorders due to the use of tobacco remain largely unexplored. This study aims to investigate the relationship between dietary iron intake and mental and behavioral disorders due to the use of tobacco. Methods: Using large population cohort data from the UK Biobank (500,000 participants at 22 assessment centers between 2006 and 2010), we employed logistic and Cox regression analyses to explore both cross-sectional and longitudinal associations between dietary iron intake and mental and behavioral disorders due to the use of tobacco. Additionally, we assessed the nonlinear relationship between dietary iron intake and these disorders using restricted cubic spline plots. Results: Logistic regression analysis indicated that dietary iron intake was negatively associated with mental and behavioral disorders due to the use of tobacco. The Cox regression results supported a protective effect of increased dietary iron intake against these disorders. Stratified and sensitivity analyses were consistent with the primary findings. Restricted cubic spline plots revealed a nonlinear relationship between dietary iron intake and mental and behavioral disorders due to the use of tobacco. In the total sample, as well as in both age groups and the male subgroup, the risk reduction rate initially accelerated before slowing down. In contrast, the risk reduction rate in the female group declined rapidly at first and then leveled off. Conclusions: This study demonstrates that dietary iron intake has a protective effect against mental and behavioral disorders due to the use of tobacco, revealing a nonlinear association between these two traits. These findings provide important insights for the profilaxy and treatment of mental and behavioral disorders due to the use of tobacco in the future.

Higher CSF sTREM2 attenuates APOE ε4-related risk for amyloid pathology in cognitively intact adults: The CABLE study.

The triggering receptor expressed on myeloid cells 2 (TREM2) is a transmembrane protein found in microglia within the brain, and its soluble form (sTREM2) has been shown to reduce amyloid deposition. Whether elevated TREM2-mediated microglial activity decreases the risk of Alzheimer's disease (AD) is unclear. The aim of this study was to assess whether high cerebrospinal fluid (CSF) levels of sTREM2 attenuate the risk of APOE ε4-associated amyloid pathology. We included 877 cognitively intact subjects from the Chinese Alzheimer's Biomarker and LifestylE (CABLE) study, including APOE ε4 carriers (n = 136) and non-carriers (n = 741). The linear regression was used to examine the interaction effect between CSF sTREM2 levels and APOE ε4 status on CSF Aβ42 levels. Additionally, subgroup analyses stratified by sex and age were conducted. Our main finding was that higher concentrations of CSF sTREM2 attenuated the effect of APOE ε4 carriage (i.e., the sTREM2 × APOE ε4 interaction) on amyloid deposition (β = -2.701e-05, p = 0.023). Subgroup analyses showed that the effect of interaction was still significant only in male (p = 0.041) and mid-life (p = 0.013) subgroups. Our study suggested that in cognitively intact individuals, changes in sTREM2 levels are associated with biomarkers of AD, and higher concentrations of CSF sTREM2 attenuated the risk of APOE ε4-related amyloid pathology. The identified role of the sTREM2 × APOE ε4 interaction in amyloid pathology offers new insights into potential strategies for AD prevention in APOE ε4 carriers.

Drug Overdose Deaths in Mexican-Heritage Arizonans: An Examination of Mortality Rates, Demographics, Drugs Involved, and Place of Death

Objective This study examined drug overdose deaths in Mexican-heritage Arizonans, with the goal of informing tailored overdose prevention programs for this community. Methods We analyzed death certificate data (from the Arizona Department of Health Services) for drug overdose deaths among Arizona residents from 2018-2022. We compared deaths in US-born and foreign-born Mexican-heritage Arizonans and, as a frame of reference, Non-Hispanic (NH) White Arizonans. We compared demographics, circumstances of death, and mortality rates, using descriptive statistics, multinomial logistic regression models, and age-standardized mortality rates and ratios. Results The age-standardized drug overdose mortality rate (per 100,000) was lower in the overall Mexican-heritage population (28.0) than in the NH White population (35.9). Nonetheless, the rate in the US-born Mexican-heritage male subgroup (59.5) was higher than in US-born NH White males (49.9) or any other subgroup examined. Synthetic opioids such as fentanyl were involved in higher proportions of deaths among US-born (64.6%) and foreign-born (65.1%) Mexican-heritage Arizonans than among NH White Arizonans (48.5%). In multinomial regression models, the risk of a medical place of death, relative to death at home, was significantly higher in the foreign-born (adjusted Relative Risk Ratio [aRRR] 1.82; 95% Confidence Interval [CI], 1.38-2.42) and US-born (aRRR 1.85; 95% CI, 1.62-2.11) Mexican-heritage groups than the NH White group, adjusting for age, sex, marital status, county of residence, overdose intent, and drugs involved. Conclusions Findings highlight disparate rates of overdose mortality in US-born Mexican-heritage Arizona men, also underscoring racial/ethnic/nativity-based differences in overdose circumstances and decedent characteristics.

A Survey on the Evaluation of Monosodium Glutamate (MSG) Taste in Austria

The umami taste is well validated in Asian culture but remains less recognized and accepted in European cultures despite its presence in natural local products. This study explored the sensory and emotional perceptions of umami in 233 Austrian participants who had lived in Austria for most of their lives. Using blind tasting, participants evaluated monosodium glutamate (MSG) dissolved in water, providing open-ended verbal descriptions, pleasantness ratings, and comparisons to a sodium chloride (NaCl) solution. Discrimination tests excluded MSG ageusia, and basic demographic data were collected. A text semantic-based analysis (TSA) was employed to analyze the emotional valence and descriptive content of participants’ responses. The results showed that MSG was predominantly associated with neutral sentiments across the group, including both female and male subgroups. “Sour” was the most frequent taste descriptor, while “unfamiliar” characterized the perceptual experience. Pleasantness ratings for MSG and NaCl were positively correlated, suggesting that overcoming the unfamiliarity of umami could enhance its acceptance and align it with the pleasantness of salt. These findings advance the understanding of umami sensory perception and its emotional and cultural acceptance in European contexts, offering valuable insights for integrating umami into Western dietary and sensory frameworks.

Systematic assessment of COVID-19 host genetics using whole genome sequencing data.

Courses of SARS-CoV-2 infections are highly variable, ranging from asymptomatic to lethal COVID-19. Though research has shown that host genetic factors contribute to this variability, cohort-based joint analyses of variants from the entire allelic spectrum in individuals with confirmed SARS-CoV-2 infections are still lacking. Here, we present the results of whole genome sequencing in 1,220 mainly vaccine-naïve individuals with confirmed SARS-CoV-2 infection, including 827 hospitalized COVID-19 cases. We observed the presence of autosomal-recessive or likely compound heterozygous monogenic disorders in six individuals, all of which were hospitalized and significantly younger than the rest of the cohort. We did not observe any suggestive causal variants in or around the established risk gene TLR7. Burden testing in the largest population subgroup (i.e., Europeans) suggested nominal enrichments of rare variants in coding and non-coding regions of interferon immune response genes in the overall analysis and male subgroup. Case-control analyses of more common variants confirmed associations with previously reported risk loci, with the key locus at 3p21 reaching genome-wide significance. Polygenic scores accurately captured risk in an age-dependent manner. By enabling joint analyses of different types of variation across the entire frequency spectrum, this data will continue to contribute to the elucidation of COVID-19 etiology.

Patterns of Dyslipidemia Among Patients with Diabetes Mellitus

Background: Diabetes mellitus presents a prevalent endocrine and metabolic challenge globally. Type-2 diabetic patients exhibit a heightened incidence of dyslipidemia, characterized by elevated low-density lipoprotein (LDL), diminished high-density lipoprotein (HDL), or increased triglycerides (TG) levels. This phenomenon poses a significant public health concern both internationally and within our nation. Objective: This study aimed to assess the patterns of dyslipidemia among diabetes patients. Methods: This cross-sectional observational study was conducted at the Outpatient Department (OPD) of Shaheed Ziaur Rahman Medical College Hospital, Bogura, from July 2018 to June 2019. Both male and female patients with Type2 diabetes were considered as the study population. A total of 90 patients were selected as study subjects through purposive sampling.The study included 45 diabetic patients on therapy, divided into male (A1, n=19) and female (A2, n=26) subgroups. Additionally, 45 newly diagnosed diabetic patients were categorized into male (B1, n=15) and female (B2, n=30) subgroups.Analysis was performed by using SPSS (Statistical Package for Social Science) version 22.0. Results: The study found similar ages and BMI among groups. Elevated serum TC was noted in 31.6%, 19.2%, 26.7%, and 30% of subjects in A1, A2, B1, and B2 respectively. High serum TG levels were observed in 36.8%, 38.5%, 40%, and 66.7% of subjects in the respective groups. Dyslipidemia prevalence varied, with A1 at 57.9%, A2 at 53.8%, B1 at 46.7%, and B2 at 76.7%. High HbA1C was prevalent in B1 and B2 (100%). Conclusion: Dyslipidemia patterns among diabetes patients exhibit significant variability, with elevated serum total cholesterol, triglycerides, and low-density lipoprotein levels, alongside reduced high-density lipoprotein levels, commonly observed. These findings underscore the importance of tailored lipid management strategies in mitigating cardiovascular risk in this high-risk population. J Rang Med Col. September 2024; Vol. 9, No. 2: 78-83

Neurotransmitter Metabolic Disturbance in Methamphetamine Abusers: Focus on Tryptophan and Tyrosine Metabolic Pathways

Methamphetamine (METH) abuse disrupts the homeostasis of neurotransmitter (NT) metabolism, contributing to a wide range of neurological and psychological disorders. However, the specific effects of METH on NT metabolism, particularly for the tryptophan (TRP) and tyrosine (TYR) metabolic pathways, remain poorly understood. In this study, serum samples from 78 METH abusers and 79 healthy controls were analyzed using Ultra-High-Performance Liquid Chromatography with Tandem Mass Spectrometry (UHPLC-MS/MS). A total of 41 substances, primarily from the TRP and TYR metabolic pathways, were detected and subjected to multivariate analysis. Principal Component Analysis (PCA) and Partial Least Squares Discriminant Analysis (PLS-DA) revealed a significant separation of serum metabolites between METH abusers and controls, encompassing the disturbance of serotonergic, kynurenic, and microbial metabolism. In the serotonergic pathway, METH significantly reduced melatonin (MLT) levels and impaired the conversion of serotonin (5-HT) to N-acetylserotonin (NAS), a key precursor of MLT. In the kynurenic pathway, METH promoted a shift to the toxic metabolic pathway, evidenced by elevated levels of 3-hydroxykynurenine (3-HK) and quinolinic acid (QA). Furthermore, microbial metabolic pathway-related indole and its derivatives were markedly suppressed in METH abusers. Gender-specific differences were also observed, with NT metabolism in TRP and TYR pathways showing more pronounced alterations in male or female subgroups. Therefore, the current study provides a comprehensive overview of the disturbance in TRP- and TYR-associated NT metabolism caused by METH abuse and highlights NT metabolism as a promising therapeutic target for METH-induced neural and psychiatric disorders.

Associations Between Fundamental Movement Skills, Muscular Fitness, Self-Perception and Physical Activity in Primary School Students.

Background/Objectives: Positive self-perception, physical activity and fundamental movement skill (FMS) proficiency are important aspects of a child's healthy development. The objective of this research was twofold: first, to explore associations between FMS, muscular fitness, self-perception and physical activity in school children; and second, to identify key predictors of FMS proficiency, athletic self-perception, physical activity levels in these participants and the differences between biological sexes. Methods: Primary school-aged children (n = 104; 53.85% female) from 8 to 10 years old (M = 9.04, SD = 0.69) engaged in two days of testing. All students were measured on FMS, standing long jump (SLJ), countermovement jump (CMJ), seated medicine ball chest throw and self-perception, followed by correlation and stepwise multiple linear regression analyses. Results: The findings revealed significant positive correlations between FMS proficiency, lower body muscular fitness (CMJ, SLJ), and athletic self-perception for the entire cohort, with varying results between male and female subgroups. Additionally, athletic self-perception showed strong relationships with other self-perception domains. Notably, forward stepwise regression analysis identified FMS proficiency as a significant predictor of physical activity levels, explaining 12.8% of the variance. SLJ, scholastic perception, and physical activity explained 45.5% of FMS variance for females. In males, FMS proficiency significantly predicted physical activity, accounting for 13.3% of the variance. SLJ and athletic competence self-perception explained 42.1% of FMS variance in males. Conclusions: The study indicates that FMS, self-perception, muscular fitness, and physical activity levels may mutually enhance each other, and that there is a need for biological sex-specific strategies to be considered in physical education programs.

Gender differences in the prevalence and clinical correlates of suicide attempts in young first-episode drug-naïve major depressive disorder patients with thyroid dysfunction

Thyroid dysfunction is commonly seen in major depressive disorder (MDD), and is particularly prevalent in female patients. Moreover, gender differences occur in many aspects of MDD, including suicide attempts (SAs). We aimed to explore gender differences in the prevalence and clinical correlates of SAs in young first-episode drug-naïve MDD patients with thyroid dysfunction, which have not yet been reported. We recruited 509 patients in this study. Demographic and clinical characteristics were collected. We used HAMD-17, HAMA-14, the positive subscale of PANSS, and CGI-S to assess every participant. We found no significant difference in the prevalence of SAs between male and female subgroup. Gender differences in factors associated with SAs were found with anxiety, body mass index, serum anti-thyroid antibodies (A-TPO), and free triiodothyronine levels in male patients and anxiety, CGI-S score, and A-TPO in female patients. We found no gender differences in the prevalence of SAs; however, there were gender differences in several clinical correlates of SAs, highlighting specific strategies to avoid SAs in male and female MDD patients.

Multidimensional assessment of exertional dyspnea in young healthy males and females who select unsatisfied inspiration at peak exercise.

Historically, it was thought that healthy humans predominantly described their breathing as a sense of increased work or effort (W/E) during maximal exercise. However, emerging data shows that many healthy adults select unpleasant dyspnea descriptors such as "unsatisfied inspiration" (UI), with relatively more females selecting UI than males. We hypothesized that males and females who select UI would report higher dyspnea intensity ratings during exercise; select more distressing dyspnea qualities post-exercise; and have greater inspiratory constraints than those who do not. Sixty-four healthy, non-smokers (32M:32F; 23±5yr) completed questionnaires, pulmonary function tests, and maximal incremental cycling with detailed dyspnea evaluation. Males in UI and Non-UI subgroups reported similar Borg 0-10 dyspnea intensity ratings of W/E, UI, and unsatisfied expiration (UE) (all P>0.05). Females in the UI subgroup reported significantly higher UI and UE ratings than females in the Non-UI subgroup (both P<0.01). Both UI subgroups reported greater air hunger, chest tightness, and mental breathing effort than Non-UI participants (all P<0.05). In males only, masculine gender was negatively correlated (r=-0.402, P=0.02) and anxiety positively correlated (r=0.363, P=0.04) with submaximal UI ratings. Females with UI had smaller peak tidal volume (VT) (1.74 (0.32) vs 2.06 (0.33) L, P=0.03) than Non-UI females; and VT was negatively correlated with submaximal (r=-0.496, P=0.004) and peak (r=-0.495, P=0.004) UI ratings in all females. There were no differences in VT or correlations between VT and dyspnea in male subgroups. Absolute lung volumes and psychosocial factors appear important in understanding sex differences in the perception of UI during exercise.

Development of Modic Changes After Percutaneous Endoscopic Transforaminal Lumbar Discectomy: From Risk Analysis to Prediction Modeling.

This study examines the occurrence of Modic changes (MC) within the first year following percutaneous endoscopic transforaminal lumbar discectomy (PETD) and investigates associated risk factors. This study adopted a retrospective cohort design. Between January 2019 and June 2023, 538 patients diagnosed with single-level lumbar disc herniation and treated with PETD were included. The patients were divided into a training set and a validation set based on their surgery dates. Preoperative radiographic parameters and perioperative indicators were evaluated. Univariate analysis examined risk factors for postoperative MC. Gender-specific subgroups were analyzed. Binary logistic regression developed a predictive model for postoperative MC, assessed using ROC, calibration, and decision curves. The incidence of MC at one year after PETD was 24.8%. Logistic regression identified 8 significant risk factors for MC after PELD: longer symptom duration, proximity of herniated segment to sacrum, severe disc degeneration, reduced disc height, greater vertebral endplate concavity angle, segmental instability, and lumbar-sacral fusion. Menopause and herniation type were identified as female-specific risk factors. In males, total cholesterol levels were additionally found to be a risk factor for postoperative MC. The male and female subgroup models exhibited satisfactory performance across ROC analysis, calibration plots, and decision curve analysis. Specifically, for male patients, the area under the curve (AUC) was 0.831 for the training set and 0.820 for the validation set; for female patients, the AUC was 0.911 for the training set and 0.868 for the validation set. A nomogram was developed to visualize the model. This study explored the relevant risk factors of MC after PETD and visualized the prediction model by nomogram, which is beneficial to optimize the surgical scheme of PETD to improve the clinical efficacy.

Association between metabolic dysfunction-associated steatotic liver disease and risk of thyroid cancer: a systematic review and meta-analysis.

Several studies have reported associations between metabolic dysfunction-associated steatotic liver disease (MASLD) and the risk of various cancers. However, studies focusing specifically on the association between MASLD and thyroid cancer are relatively limited, and the conclusions drawn, thus, far remain inconclusive. In response, we conducted a meta-analysis of relevant cohort studies to clarify the association between MASLD and the risk of thyroid cancer. We systematically searched the Web of Science, Embase, Cochrane Library, and PubMed databases for articles published before 24 September 2024. We utilized the R software (version 4.4.1) for the comprehensive execution of all statistical analyses. Our meta-analysis included eight cohort studies (six retrospective and two prospective), comprising 18 925 396 participants. The pooled results of the eight cohort studies indicate that MASLD is linked to an increased risk of thyroid cancer (HR = 1.46; 95% CI: 1.14-1.86; I ² = 69%; P < 0.01). A random-effects model was employed due to moderate heterogeneity ( I ² > 50%). Subgroup analyses revealed that the association between MASLD and thyroid cancer risk was stronger in the Chinese population (HR = 2.24; 95% CI: 1.32-3.81; I ² = 51%) and among overweight individuals (HR = 1.29; 95% CI: 1.02-1.63; I ² = 90%). No significant differences were identified between male and female subgroups. This meta-analysis demonstrates that MASLD increases the risk of developing thyroid cancer.

Chest-CT-based radiomics feature of epicardial adipose tissue for screening coronary atherosclerosis.

This study aims to investigate the diagnostic value of chest-CT epicardial adipose tissue (EAT) radiomics feature in coronary atherosclerotic stenosis. Clinical data from 215 individuals who underwent coronary angiography and chest-CT scan from January to July 2022 at our institution were retrospectively analyzed. Based on the coronary angiography results, the total population, men, and women were divided into the CAD group and non-CAD group. radiomics feature of EAT at the level of the bifurcation of the left-main coronary artery on the transverse level of chest CT were measured. The features contain both first-order feature and shape-order feature.The differences between groups were analyzed using the t test or Chi-square test. The diagnostic efficacy of each parameter in diagnosing atherosclerotic stenosis of coronary arteries was assessed by plotting the receiver operating characteristic (ROC) curve. First-order features: Mean, IntDen, Median, and RawIntDen; shape-order features: Area, Perim, Round, and BSA index; and clinical index: HbA1c showed statistical significance between the CAD group and the non-CAD group. The ROC curve analysis demonstrated high diagnostic efficacy, with the best for diagnostic efficacy being Median for the first-order feature parameter (AUC, 0.753; 95% confidence interval [CI], 0.689-0.817; t = 4.785, p < 0.001), Round for the shape-order feature (AUC, 0.775; 95% CI, 0.714-0.836; t = 7.842, p < 0.001), and HbA1c for the clinical index (AUC, 0.797; 95% CI, 0.783-0.856; t = 6.406, p < 0.001). After dividing the participants into male and female subgroups, the best diagnostic efficacy was observed with the BSA index for men (AUC, 0.743; 95% CI, 0.656-0.829; t = 5.128, p < 0.001) and Round for women (AUC, 0.871; 95% CI, 0.793-0.949; t = 7.247, p < 0.001). Median, Round in radiomics feature of EAT on chest CT may play a role in the assessment of coronary atherosclerotic stenosis.

Patient characteristics and incidence of cardiac amyloidosis: an observational study in the UK clinical setting using electronic health records

Abstract Background Cardiac amyloidosis (CA) is associated with a high mortality rate due to sudden or progressive heart failure. It is often misdiagnosed due to non-specific symptoms, and its true incidence and prevalence in the United Kingdom (UK) remain uncertain. Purpose To describe patient characteristics and incidence of CA in the UK clinical setting using electronic health records. Methods In this retrospective observational study, anonymised, linked primary and secondary care data (Clinical Practice Research Datalink, CPRD and Hospital Episode Statistics, HES) were used to describe individuals diagnosed with CA. The CPRD database contains de-identified patient data sourced from a sample of general practitioner (GP) practices in the UK. Patients aged 18 years and older with a recorded Read or SNOMED-CT diagnosis code for CA or record of treatment with tafamidis (a licensed but not reimbursed treatment for transthyretin amyloid cardiomyopathy, ATTR-CM in the UK) in the period between January 2004 to December 2021 were included. The index date was defined as the earliest recorded date of CA diagnosis or tafamidis treatment. Demographic and clinical data were summarised using descriptive statistics. Incidence rates were reported per 100,000 person-years (PY). Results There were a total of 3,788 patients with CA (mean age: 67 years; 61% males) of which only 277 were coded as having wild-type transthyretin (ATTRwt) CA in mostly older patients (mean age: 79 years). The low patient counts of ATTRwt amyloidosis could be attributed to the lack of specificity in CA types and the low utilisation of ATTR amyloidosis codes. Heart Failure, essential hypertension and dyspnoea were the most common clinical presentations recorded in the 12 months to first diagnosis code or tafamidis prescription for CA (Table). The incidence of CA varied from 0.75 in 2004 to a peak of 1.96 in 2021, per 100,000 PY; a 2.9-fold increase in newly coded diagnoses in CA. There was a slight decline in the rates in 2020 and 2021 (Figure). Incidence rates in males and females increased over the 17-year period, with males consistently having higher rates than females. The incidence rate in females started from a lower base at 0.62/100,000 PY in 2004, increased by a factor of 1.9 to 1.1/100,000 PY, whereas in males it started at 0.88/100,000 PY and rose by a factor of 2.9 to 2.5 /100,000 PY. Incidence rates in subgroup populations have also been analysed. Conclusions In the UK clinical setting, the incidence rate of newly coded CA increased overall between 2004 and 2021, as well as in both male and female subgroups. The data suggest CA is becoming more common, or that awareness has improved, and there is now an urgent need for enhanced methods of detection, characterisation, and the need for thorough data capture to shape future pathway advancements.

Relationship between fibrosis-4 index and new onset hypertension in the general population

Abstract Background/Introduction Non-alcoholic fatty liver disease (NAFLD) is a risk for cardiovascular events and malignant tumors as well as liver cirrhosis, and the risk increases with increasing fibrosis of the liver. Thus, the fibrosis-4 (FIB-4) index, developed as a noninvasive test to stage liver fibrosis, may predict the development of hypertension. Purpose The present study investigated the relationship of FIB-4 index with the prevalence and future development of hypertension in the general population. Methods A total of 16125 participants who visited our hospital for a physical check-up at least twice from 2008 to 2018 (male=9700, 52.0±12.3 year-old) were subjected for cross-sectional analysis. Among them, 3995 participants were hypertensive. The remaining 12111 normotensive participants (male=6984, 49.5±11.9 year-old) were followed up for the median of 1643 days with the endpoint being the development of hypertension, defined as systolic blood pressure ≥140mmHg, diastolic blood pressure ≥90mmHg or the use of antihypertensive medication. FIB-4 index was calculated as follows; (age×AST)/(platelet number×√ALT). Results Cross-sectional analysis revealed that FIB-4 index was higher in hypertensive than normotensive participants (1.40±0.74 vs. 1.09±0.54, p&amp;lt;0.001). During the follow-up, 2819 participants (45.7 per 1000 person-year) developed hypertension. The incidence was more frequent in male (55.6 per 1000 person-year) than female participants (32.7 per 1000 person-year, p&amp;lt;0.001). High level of FIB-4 index (≥2.67, n=194) showed a significant impact on the incident hypertension (80.5 per 1000 person-year) as compare with middle (≥1.30, &amp;lt;2.67, n=3082) or low level (&amp;lt;1.30, n=8835) of FIB-4 index (65.4 and 38.8 per 1000 person-year, respectively). Non-adjusted hazard ratio (HR) (95% confidence interval [CI]) of FIB-4 index for the new onset of hypertension was 1.483 (1.416-1.553). In multivariate Cox hazard analysis adjusted for sex, body mass index, systolic blood pressure, pulse rate, serum creatinine, uric acid, HbA1c, LDL-cholesterol, triglyceride, hemoglobin, current smoking, frequent alcohol consumption and family history of hypertension, FIB-4 index was an independent predictor of the development of hypertension (HR 1.321, 95%CI [1.213-1.438]). Similar results were obtained in analyses of male (HR 1.382, 95%CI [1.300-1.470]) and female subgroups (HR 1.369, 95%CI [1.230-1.524]). History of viral hepatitis or frequent alcohol consumption did not affect the results (data not shown). Conclusions FIB-4 index is a useful predictor of the development of hypertension in the general population. Increased risk of cardiovascular events in patients with NAFLD may partially be attributable to the development of or coexistence with hypertension.

Early sedation using ciprofol for intensive care unit patients requiring mechanical ventilation: a pooled post-hoc analysis of data from phase 2 and phase 3 trials

BackgroundCiprofol was approved for use in intensive care unit (ICU) patients requiring sedation during mechanical ventilation in July 2022. A pooled post-hoc analysis of phase 2 and phase 3 trials was conducted primarily to explore hypotension-free outcome in ICU patients who required mechanical ventilation and achieved the target light sedation goal at an early stage after being sedated with ciprofol or propofol.MethodsAll eligible ICU patients who were expected to require sedation for 6–24 h were randomly assigned in a 2:1 ratio to either a ciprofol or propofol group. Ciprofol or propofol was initially infused at loading doses of 0.5 or 1.0 mg/kg followed by maintenance doses of 0.3 or 1.5 mg/kg/h. Ciprofol or propofol dosages were adjusted up or down at rates of 0.05–0.10 mg/kg/h or 0.25–0.50 mg/kg/h, respectively, to achieve the target light sedation (a Richmond Agitation-Sedation Scale of -2 to + 1). The primary post-hoc outcome was the hypotension-free rate in patients who had achieved the target sedation goal after 30-min administration of ciprofol or propofol.ResultsIn total, 174 patients were enrolled for pooled post-hoc analysis, of whom 116 and 58 were assigned to the ciprofol and propofol groups, respectively. The hypotension-free rate was significantly higher in patients who achieved the target sedation goal after 30-min administration of ciprofol (93.0% vs. 81.0%, P = 0.018), and especially in the subgroups of males and patients aged < 65 years. Multivariable analysis revealed that ciprofol treatment, a younger age and lower baseline body mass index were independent favorable predictors for a higher hypotension-free rate in patients who achieved the target sedation goal after 30-min of drug administration. Moreover, hypotension-free patients who reached the target sedation level after 30 min had a more favorable short-term prognosis including a lower incidence of drug-related treatment-emergent adverse events, shorter time to extubation and fewer dose adjustments of ciprofol or propofol (all P < 0.05).ConclusionICU patients undergoing mechanical ventilation and sedated with ciprofol had significantly lower rate of hypotension during the early phase of achieving light sedation during a 6–24 h period, leading to a more favorable short-term prognosis (within 24 h).Trial registrationPhase 2 trial (clinicaltrials.gov, NCT04147416. Registered November 1, 2019, https://classic.clinicaltrials.gov/ct2/show/NCT04147416) and phase 3 trial (clinicaltrials.gov, NCT04620031. Registered November 6, 2020, https://classic.clinicaltrials.gov/ct2/show/NCT04620031).

Association between plasma trimethylamine N-oxide and coronary heart disease: new insights on sex and age differences.

Elevated plasma trimethylamine N-oxide (TMAO) is related to atherosclerosis. Whether the relationship of TMAO and coronary heart disease (CHD) is influenced by sex or age is uncertain. We aim to explore the sex and age differences in the relationship between plasma TMAO and CHD risk and severity. A case-control study was conducted in patients undergoing elective coronary angiography. Matched by sex, age (±2 years), and operation date (±180 days), a total of 429 CHD case-control pairs were included. Plasma TMAO was quantified using liquid chromatography-tandem mass spectrometry. Logistic regression analyses were performed to evaluate the association between plasma TMAO and CHD risk and severity. The overall median (interquartile range) plasma TMAO level was 0.11 (0.06-0.18) μg/ml. After stratification by sex and age, and adjustment for common CHD risk factors, the association between TMAO and CHD risk was significant in the older (≥65 years) male subgroup [odds ratios (OR) = 1.57, 95% confidence interval (CI): 1.09-2.28, P = 0.016], but not in other sex-age subgroups (all P > 0.05). The relationship of plasma TMAO and CHD risk was modified by age (adjusted P interaction = 0.001) in male individuals. Plasma TMAO was also associated with a higher risk of multi-vessel disease in male patients with CHD (OR = 1.65, 95% CI: 1.18-2.32, P = 0.004), but not in females. Plasma TMAO is significantly positively associated with the risk and severity of CHD in Chinese men. Age has an interactive effect on the relationship between plasma TMAO and CHD risk in men. Our findings warrant further investigation.