Management Of Young Patients Research Articles

A Nomogram for Predicting Cancer-Specific Survival in Young Patients With Advanced Lung Cancer Based on Competing Risk Model.

Young lung cancer is a rare subgroup accounting for 5% of lung cancer. The aim of this study was to compare the causes of death (COD) among lung cancer patients of different age groups and construct a nomogram to predict cancer-specific survival (CSS) in young patients with advanced stage. Lung cancer patients diagnosed between 2004 and 2015 were extracted from the Surveillance, Epidemiology, and End Results (SEER) database and stratified into the young (18-45 years) and old (> 45 years) groups to compare their COD. Young patients diagnosed with advanced stage (IVa and IVb) from 2010 to 2015 were reselected and divided into training and validation cohorts (7:3). Independent prognostic factors were identified through the Fine-Gray's test and further integrated to the competing risk model. The area under the receiver operating characteristic curve (AUC), consistency index (C-index), and calibration curve were applied for validation. The proportion of cancer-specific death (CSD) in young patients was higher than that in old patients with early-stage lung cancer (p < 0.001), while there was no difference in the advanced stage (p = 0.999). Through univariate and multivariate analysis, 10 variables were identified as independent prognostic factors for CSS. The AUC of the 1-, 3-, and 5-year prediction of CSS was 0.688, 0.706, and 0.791 in the training cohortand 0.747, 0.752, and 0.719 in the validation cohort. The calibration curves demonstrated great accuracy. The C-index of the competing risk model was 0.692 (95% CI: 0.636-0.747) in the young patient cohort. Young lung cancer is a distinct entity with a different spectrum of competing risk events. The construction of our nomogramcan provide new insights into the management of young patients with lung cancer.

Radiographic features and molecular subtypes association of breast cancer in women younger than 40 years old

Background: Breast cancer is the most commonly diagnosed cancer and the leading cause of cancer death among females, particularly in women under the age of 40 years. However, early detection of breast cancer in this population remains challenging and it tends to present at a later stage with poorer prognosis.Objective: To review mammographic and ultrasonographic findings, pathological features and molecular subtypes of breast cancer in younger than 40-year-old patients diagnosed in King Chulalongkorn Memorial Hospital and to determine which radiological characteristics are associated with molecular subtypes. Materials and Methods: The study included 278 patients aged under 40 years who were diagnosed with breast cancer and underwent mammographic and ultrasonographic studies between January 2009 and December 2019. A retrospective review of mammographic and ultrasonographic findings, histopathological reports as well as biological markers were made. The association of radiological characteristics and molecular subtypes was analyzed by SPSS. Results: In the 278 patients, the most common clinical presentation was palpable mass (268, 96.4%). The common mammographic findings were irregular shape mass (196, 77.8%) with hyperdensity (114, 45.2%) and an obscured margin (99, 39.3%). Presenting of microcalcification is not frequent (122, 48.4%). We found 27 patients with normal mammograms which were later detected in ultrasounds as 25 masses, 1 intraductal lesion and 1 focal duct change. The predominant ultrasonographic features were irregular shape mass (257, 91.5%), an angular margin (89, 31.7%), hypoechogenicity (198, 70.5%), no posterior feature (210, 74.7%) and internal vascularity (170, 60.5%). These radiological characteristics were classified as BI-RADS 5 in 194 lesions (69%). The most common histopathological type was mixed-type carcinoma (143, 50.9%), followed by invasive ductal carcinoma (114, 40.6%). Luminal B was the mostly found in this study (86, 30.6%). The patients frequently presented with stage IIA (91, 32.7%) while 15 patients were detected with an advanced stage at the first presentation. We found that triple negative, HER 2 overexpression and luminal B subtypes were associated with an obscured mass on mammography (p 0.048). Luminal B and HER 2 overexpression subtypes were also associated with the presence of fine pleomorphic microcalcification (p &lt;0.001). Conclusion: In this study, we found an association of the mass margin and suspicious calcification morphology on mammography with molecular subtypes. It would be helpful for further clinical management in young patients. The knowledge can be used for planning appropriate treatments according to molecular subtypes which are associated with these characteristics. However, the precision of cancer treatment is still based on the tissue diagnosis.

Erratum: Commentary: Rehabilitation: a key service, yet highly underused, in the management of young patients with sickle cell disease after stroke in DR of Congo

Erratum: Commentary: Rehabilitation: a key service, yet highly underused, in the management of young patients with sickle cell disease after stroke in DR of Congo

Rehabilitation: a key service, yet highly underused, in the management of young patients with sickle cell disease after stroke in the Democratic Republic of Congo

Rehabilitation: a key service, yet highly underused, in the management of young patients with sickle cell disease after stroke in the Democratic Republic of Congo

Takayasu arteritis presenting as a stroke in young: a case report

Introduction: Takayasu arteritis is a large-vessel vasculitis predominantly seen in young women. Lack of signs and symptoms in the early stage of the disease often delays the diagnosis and thus leads to significant morbidity and mortality. One severe complication that may arise is a significant narrowing of blood vessels, potentially leading to life-threatening ischemic repercussions. Case presentation: The authors present a case of a 29-year-old female who presented to our ER with features of left-sided hemiparesis and right-sided facial deviation. Computed tomography angiography and Carotid Doppler helped in making the diagnosis of Takayasu arteritis. She was managed with prednisolone and mycophenolate mofetil. She has been on a regular follow-up for the last year and is currently stable. Conclusion: Even being a rare scenario, stroke can be the initial presentation of Takayasu arteritis. Early diagnosis and management in young patients are vital in keeping the disease at bay and preventing physical, mental, and socio-economic adversities.

Conservative treatment of large unicystic ameloblastoma in a young patient: a 7-year follow-up

The unicystic ameloblastoma is an odontogenic tumor that is frequently found in young patients and usually affects the posterior region of the mandible. This paper aimed to describe a case report and 7-year follow-up of a young patient. The 12-year-old patient presented with increased volume in the lower third of the right hemiface with a duration of 6 months. Radiographic examination showed a unilocular radiolucent lesion extending along the body, angle and right mandibular ramus. An incisional biopsy was performed and a histological diagnosis of luminal unicystic ameloblastoma was obtained, opting for a conservative treatment with decompression and subsequent complete enucleation of the lesion. The patient has been under follow-up for 7 years, with a good evolution of the condition and without clinical and radiographic signs of recurrence of the lesion. Thus, it is ratified that timely conservative intervention and conservative surgical treatment should be the first choice for ameloblastoma management in young patients.

Rehabilitation: a key service, yet highly underused, in the management of young patients with sickle cell disease after stroke in DR of Congo.

Rehabilitation: a key service, yet highly underused, in the management of young patients with sickle cell disease after stroke in DR of Congo.

Aortic valve replacement for aortic stenosis in patients under 65-years-old

Aortic valve stenosis is the most common valve disease in the world, with particularly poor prognosis if left untreated. Its management in young patients is based on surgical aortic valve replacement (bioprosthesis or mechanical prosthesis, and Ross or Ozaki technique), and rarely percutaneous (TAVR). In this population, the choice of the technique used is of primary importance in terms of hemodynamic performance and durability. The objective of this work is to compare 5 different techniques used in the management of aortic stenosis in patients under 65 years old at CHRU of Tours. We conducted a retrospective, single-center, observational study at the CHRU of Tours. Five cohorts (mechanical prosthesis, INSPIRIS bioprosthesis, Ross, Ozaki and TAVR) were compared in terms of pre-, per- and postoperative, clinical and hemodynamic parameters. We included 163 patients under 65-years-old with aortic stenosis operated at the CHRU of Tours between January 2015 and October 2021. Hemodynamically, after stratification on the prosthetic caliber, the best results were found with the Ozaki and Ross techniques, followed by TAVR, the INSPIRIS bioprosthesis and finally the mechanical prosthesis. A severe prosthesis-patient mismatch rate of 10% was found in all patients, with no significant difference between the different techniques (P = 0.1827). Clinically, there was no significant difference between the groups in terms of mortality or re-intervention related to the aortic valve after a mean follow-up of 19.2 months (P = 0.6545). However, pacemaker implantation was significantly higher in the TAVR group (P = 0.0178). Each surgical and percutaneous technique has its specific advantages and complications. The excellent short-term hemodynamic parameters of the Ross and Ozaki techniques seem to encourage the use of these techniques in the management of aortic stenosis in young patients. More powerful studies with a longer follow-up time would allow to confirm these preliminary results.

The Role of Methylation of Host and/or Human Papillomavirus (HPV) DNA in Management of Cervical Intraepithelial Neoplasia Grade 2 (CIN2) Lesions.

Cervical intraepithelial neoplasia grade 2 (CIN2) is an intermediate stage between CIN 1, which is a low-grade lesion, and CIN3, which is the immediate precursor of cervical cancer (CC). Traditionally, CIN2 was regarded as a high-grade lesion and was treated with conization or ablative methods. In recent years, there has been a shift in the management of younger patients, who are now more often being managed conservatively due to frequent spontaneous CIN2 regression and possible adverse effects of treatment on future pregnancies. Because the risk of progression to CC still exists with conservative management, a personalized approach is needed to identify patients with a higher probability of progression. In this regard, research has focused on the role of host and human papillomavirus (HPV) gene methylation. This systematic review summarizes the current knowledge regarding conservative CIN2 management focusing on the main methylation markers and its implementation in conservative CIN2 management, and it describes major ongoing longitudinal studies on the subject. The review showed that DNA methylation is an accurate predictor of disease progression and a valid triage tool for HPV-positive women, with CIN2 performing better than triage cytology. Because virtually all CCs are methylation-positive, methylation-negative women at baseline have an extremely low risk of CC.

Post Radiation Transformation to a Sarcomatous Meningioma: a Case Report in an Adolescent Male with NF2 Genetic Mutation

Atypical meningioma is often treated adequately by complete surgical resection and subsequent radiation therapy. Nevertheless, radiation therapy should be reassessed in the management of younger patients and particularly in individuals harboring NF2 genetic mutation. To the best of our knowledge this is the third case of post radiation transformation of atypical meningioma in an adolescent male after reviewing the available English literature. Kew wards: Post radiation, atypical meningioma, transformation, sarcomatous meningioma, NF2 mutation.

Trends in management of cardiovascular risk factors in young adults who go on to develop coronary artery disease

Abstract Background Rates of premature coronary artery disease (CAD) have remained stagnant in many countries in the past two decades. While guidelines on cardiovascular prevention are evolving to improve risk assessment, more data are needed to evaluate changes in risk management in younger patients with high cardiovascular risk. Purpose To investigate the trends in pre-presentation prevalence and management of major cardiovascular risk factors (CVRFs) and predictors of initiation of lipid-lowering therapy (LLT) in patients with premature coronary artery disease. Methods In this retrospective cohort study, we identified women &amp;lt;55 years old and men &amp;lt;50 years old who presented with obstructive CAD (stenosis &amp;gt;50% or history of coronary revascularization) between 2000 and 2017. Data were collected from administrative databases and provincial cardiac information system and included demographics, all outpatient visits, hospitalizations, pharmacy dispenses in the period of 3 years prior to CAD, presentation characteristics, and results of invasive coronary angiography. Results In total, 14,470 patients (29.7% females) met the study criteria. During the study period, prevalence decreased for dyslipidemia and smoking and increased for hypertension, diabetes and obesity (Figure 1). Over 96.5% of patients were eligible for lipid screening 3 years prior to presentation with CAD, 93.5% had visits with primary care physicians, and 57.4% had visits with specialist physicians. Only 20.5% received LLT, with rates rising from 19% in the year 2000 to 24% in 2017 (p=0.023). Additionally, 38.1% of patients received medical treatment for other CVRFs. Figure 2 presents risk management and rates of LLT initiation in patients with five major CVRFs. In multivariable logistic regression analysis, LLT was more likely in patients with diabetes (odds ratio [OR] 3.04, 95% CI 2.74–3.36), hypertension (OR 1.44, 95% CI 1.30–1.58), chronic kidney disease (OR 1.79, 95% CI 1.44–2.23), and depression (OR 1.25, 95% CI 1.11–1.40). Later year of presentation (OR 1.04, 95% CI 1.03–1.05), older age at presentation (OR 1.03, 95% CI 1.02–1.04) and residing in urban areas vs rural (OR 1.36, 95% CI 1.16–1.58) were also positively associated with LLT. Male sex (OR 0.88, 95% CI 0.78–0.98) and smoking (OR 0.68, 95% CI 0.62–0.76) were associated with lower likelihood of treatment. Obesity, hypothyroidism, chronic inflammatory conditions, and malignancies were not significantly associated with LLT. Conclusion Despite the rising prevalence of CVRFs, high eligibility for lipid screening, and availability of care, rates of LLT initiation in patients who go on to develop premature CAD remain very low, representing a major missed opportunity for cardiovascular disease prevention. Many of the major CVRFs and risk enhancers endorsed in current guidelines were not associated with treatment initiation, suggesting that new approaches may be required to increase appropriate use LLT in these patients. Funding Acknowledgement Type of funding sources: Foundation. Main funding source(s): St. Pauls Hospital Foundation, Vancouver, BC, CanadaVancouver General Hospital Foundation, Vancouver, BC, Canada

Asthma exacerbations are associated with a decline in lung function: a longitudinal population-based study

RationaleProgressive lung function (LF) decline in patients with asthma contributes to worse outcomes. Asthma exacerbations are thought to contribute to this decline; however, evidence is limited with mixed results.MethodsThis historical...

Treatment of Gastrointestinal Stromal Tumors (GISTs): A Focus on Younger Patients.

Simple SummaryGastrointestinal stromal tumors (GISTs) are the most common mesenchymal neoplasms of the gastrointestinal tract. GISTs mainly develop in older adults, and the median age of diagnosis is 60–65 years. The incidence of GISTs in young adult patients, defined as adults before 40, is less than 10%. The frequency and type of molecular abnormalities in this group of patients are different from those in older patients. In this publication, we focus on the specificity of GISTs in young people and the principles of therapeutic management and management of the side effects of treatment.Gastrointestinal stromal tumors (GISTs) originate from Cajal’s cells and are the most common mesenchymal neoplasms of the gastrointestinal tract. GISTs in young adults, i.e., patients before the age of 40, are rare and differ from those in older patients and GISTs in children in terms of the molecular and clinical features, including the location and type of mutations. They often harbor other molecular abnormalities than KIT and PDGFRA mutations (wild-type GISTs). The general principles of therapeutic management in young patients are the same as in the elderly. Considering some differences in molecular abnormalities, molecular testing should be the standard procedure to allow appropriate systemic therapy if needed. The optimal treatment strategy should be established by a multidisciplinary team experienced in sarcoma treatment. The impact of treatment on the quality of life and daily activities, including the impact on work, pregnancy, and fertility, in this patient population should be especially taken into consideration.

A Wolff-Parkinson-White (WPW) Electrocardiographic Pattern in Asymptomatic Patient – State-of-the-Art-Review

A comprehensive approach to asymptomatic adults with Wolff-Parkinson-White (WPW) pattern discovered incidentally on routine electrocardiography (ECG) is debatable. The objective of this review article is to update the most recent evidence on the management of young patients with asymptomatic WPW patterns. A substantial proportion of adults with WPW patterns on ECG may remain asymptomatic but the lifetime risk for fatal arrhythmias still exists. The inherent properties of the accessory pathway determine the risk of sudden cardiac death. A low-risk pathway is considered when the pre-excitation is intermittent on ambulatory monitoring or when it disappears completely or abruptly during exercise testing. On the other hand, a high-risk pathway in EP study is suggested by the presence of the shortest pre-excited RR interval (SPERRI) during atrial fibrillation of ≤ 250 ms or accessory pathway effective refractory period (APERP) ≤ 240 ms. The cardiac evaluation may thus be considered in asymptomatic patients with WPW to determine the individual risk for future symptomatic arrhythmia. A shared-decision making must be performed before offering catheter ablation whose procedural success rate is high.

Impact of therapeutic strategy on disease-free and overall survival of early-stage cervical cancer: Surgery alone versus preoperative radiotherapy.

e17517 Background: At present, there is no international consensus for management of early-stage cervical cancer. This study aimed to retrospectively investigate disease-free survival (DFS) and overall survival (OS) in patients with early cervical cancer according to the therapeutic strategy used, surgery alone versus pre-operative radiotherapy following by surgery. Methods: Data from patients with early-stage cervical cancer were retrospectively collected from January 1998 to December 2015 using the Breast &amp; Gynecological Cancer Registry of the Côte d’Or, regrouping data from 7 centers. The inclusion criteria were: FIGO 2009 stage IB1 or lower; epidermoid, adenocarcinoma or adenosquamous type. The exclusion criteria were: history of pelvic radiation; concomitant radiochemotherapy; adjuvant radiotherapy; total radiation dose less than 50 Gy, or more than 66 Gy or not documented. In the surgery group, patients had only a surgical treatment for early-stage cervical cancer. The surgical treatment was either a hysterectomy, a trachelectomy or a conization. In the radiation group; patients had radiotherapy, brachytherapy and/or radiotherapy followed by surgery. DFS and OS were determined using the Kaplan-Meier method .Survival curves were compared using the log-rank test. Results: A total of 126 patients were included. Median survival in the whole population was 90 months (47-148); 72 months for those receiving primary surgery, and 135.5 months for those receiving primary radiation therapy. There was no significant difference in DFS between the surgery and radiation groups (HR=2.82, 95%CI (0.82-9.65), p=0.08). Similarly, there was no significant difference in OS between groups (HR=1.35, 95%CI (0.6-3.05), p=0.5). In the sub-group of patients with stage IB1 (FIGO 2009), there was no significant difference in DFS (HR=3.26, 95%CI (0.4-26.76), p=0.2) or in OS (HR=3.87, 95%CI (0.49-30.35), p=0.2) between groups. Conclusions: Cervical cancer counts among the only solid tumors for which increasing mortality has been observed in recent years. Radiation therapy is still a major source of morbidity for young patients. Therefore, key issues remain outstanding for the future management of young patients with cervical cancer and include reducing the morbidity of existing therapeutic options by identifying subgroups of patients at low or intermediate risk, and facilitating fertility-sparing surgery.

Evaluation of a Newly Developed Smartphone App for Risk Factor Management in Young Patients With Ischemic Stroke: A Pilot Study.

Background: Efficient treatment of modifiable vascular risk factors decreases reoccurrence of ischemic stroke, which is of uttermost importance in younger patients. In this longitudinal pilot study, we thus assessed the effect of a newly developed smartphone app for risk factor management in such a cohort.Methods: The app conveys key facts about stroke, provides motivational support for a healthy lifestyle, and a reminder function for medication intake and blood pressure measurement. Between January 2019 and February 2020, we consecutively invited patients with ischemic stroke aged between 18 and 55 years to participate. Patients in the intervention group used the app between hospital discharge and 3-month follow-up. The control group received standard clinical care. Modifiable risk factors (physical activity, nutrition, alcohol consumption, smoking behavior, obesity, and hypertension) were assessed during the initial hospital stay and at a dedicated stroke outpatient department three months post-stroke.Results: The study cohort comprised 21 patients in the app intervention group (62% male; age = 41 ± 11 years; education = 12 ± 3 years) and 21 sex-, age- and education-matched control patients with a comparable stroke risk factor profile. Baseline stroke severity was comparable between groups (intervention: median NIHSS = 3; control: median NIHSS = 4; p = 0.604). Three months post-stroke, patients in the intervention group reported to be physically almost twice as active (13 ± 9 h/week) compared to controls (7 ± 5 h/week; p = 0.022). More intense app usage was strongly associated with higher physical activity (r = 0.60, p = 0.005) and lower consumption of unhealthy food (r = −0.51, p = 0.023). Smoking behavior (p = 0.001) and hypertension (p = 0.003) improved in all patients. Patients in the intervention group described better self-reported health-related quality of life three months post-stroke (p = 0.003).Conclusions: Specifically designed app interventions can be an easily to implement and cost-efficient approach to promote a healthier lifestyle in younger patients with a stroke.

COVID-19 как фактор риска окклюзии вен сетчатки у молодых пациентов?

Retinal vein occlusions (RVOs) are thought to have more favorable outcomes in patients under-50 due to spontaneous regression. However, 20% develop severe neovascularization. In most cases, the causal link of occlusion remains elusive. Some authors report on clinical presentations typical for RVOs in the COVID-19 infection due to hypercoagulation. Management of younger patients with RVO required a complex diagnostic approach to assess systemic risk factors and obligatory evaluation of baseline retinal ischemia using fluorescein angiography (FA) or optical coherence tomography angiography (OCTA). Clinical criteria of escalating retinal ischemia are decreased central visual acuity, macular edema, increased area of ischemia, and (later) retinal and/or anterior segment neovascularization. We describe a young man with RVO after the COVID-19 infection. The COVID-19 infection had no significant effect on hemostasis parameters in this patient. Meanwhile, the COVID-19 infection cannot be ruled out as an aggravating factor in a patient with a genetic predisposition to (micro)vascular occlusions. Keywords: OCTA, retinal neovascularization, retinal vein occlusion, coagulogram, COVID-19. For citation: Shchuko A.G., Akulenko M.V., Yur’eva T.N. COVID-19 is a risk factor for retinal vein occlusion in younger patients? Russian Journal of Clinical Ophthalmology. 2022;22(1):62–67 (in Russ.). DOI: 10.32364/2311-7729-2022-22-1-62-67.

A Study on the Status and the Correlation of Stigma in Young Patients with Lung Cancer

Purpose: To explore the correlations among the status of stigma, medical coping, and general self-efficacy in young patients with lung cancer. Methods: The convenience sampling method (selecting 123 cases of young patients with lung cancer in our hospital), general questionnaire, Cataldo Lung Cancer Stigma Scale, Medical Coping Modes Questionnaire, and General Self-efficacy Scale. Results: In the young patients with lung cancer, the total scores of stigma, medical coping modes, and general self-efficacy are (74.49 ± 6.75), (48.94 ± 4.80), and (18.73 ± 5.43) respectively. According to the multiple linear regression analysis, the education level, monthly personal income, and smoking history are the main factors influencing their stigma. The stigma score is negatively correlated with envisaging, one of the medical coping modes, and general self-efficacy, and positively correlated with dodging and submission. These differences are statistically significant (p < 0.05). Conclusion: Young patients with lung cancer had moderately high levels of stigma, with education level, monthly personal income, and smoking history being the main influencing factors. Besides, more severe stigma results in worse envisaging and general self-efficacy of the medical coping modes, thus the young patients with lung cancer tended to adopt the coping modes of dodging and submission. Therefore, clinical nurses should strengthen the nursing intervention based on the information-motivation-behavioral skills model in the management of young patients with lung cancer, and provide timely psychological guidance to reduce their stigma and improve their positive coping modes and self-efficacy.

Prognostic Accuracy of the qSOFA Score for In-Hospital Mortality in Elderly Patients with Obstructive Acute Pyelonephritis: A Multi-Institutional Study.

Prognostic accuracy of the quick sequential organ failure assessment (qSOFA) score for mortality may be limited in elderly patients. Using our multi-institutional database, we classified obstructive acute pyelonephritis (OAPN) patients into young and elderly groups, and evaluated predictive performance of the qSOFA score for in-hospital mortality. qSOFA score ≥ 2 was an independent predictor for in-hospital mortality, as was higher age, and Charlson comorbidity index (CCI) ≥ 2. In young patients, the area under the curve (AUC) of the qSOFA score for in-hospital mortality was 0.85, whereas it was 0.61 in elderly patients. The sensitivity and specificity of qSOFA score ≥ 2 for in-hospital mortality was 80% and 80% in young patients, and 50% and 68% in elderly patients, respectively. For elderly patients, we developed the CCI-incorporated qSOFA score, which showed higher prognostic accuracy compared with the qSOFA score (AUC, 0.66 vs. 0.61, p < 0.001). Therefore, the prognostic accuracy of the qSOFA score for in-hospital mortality was high in young OAPN patients, but modest in elderly patients. Although it can work as a screening tool to determine therapeutic management in young patients, for elderly patients, the presence of comorbidities should be considered at the initial assessment.

The different risk factors for isolated diastolic hypertension and isolated systolic hypertension: a national survey

BackgroundHypertension is highly prevalent and is one of the modifiable risk factors for cardiovascular outcomes. Isolated diastolic hypertension (IDH), however, tends to be ignored due to insufficient recognition. We sought to depict the clinical manifestation of IDH and isolated systolic hypertension (ISH) to find a more efficient way to improve the management.MethodsPatients with primary hypertension aged over 18 years were investigated from all over the country using convenience sampling during 2017–2019. IDH was defined as systolic blood pressure (SBP) < 140 mmHg and diastolic blood pressure (DBP) ≥90 mmHg. ISH was defined as SBP ≥ 140 mmHg and DBP < 90 mmHg.ResultsA total of 8548 patients were screened, and 8475 participants were included. The average age was 63.67 ± 12.78 years, and males accounted for 54.4%. Among them, 361 (4.3%) had IDH, and 2096 had ISH (24.7%). Patients with IDH (54.84 ± 13.21 years) were much younger. Aging turned out to be negatively associated with IDH but positively associated with ISH. Multivariate logistic regression analysis showed BMI was a significant risk factor for IDH (OR 1.30, 95%CI 1.05–1.61, p = 0.018), but not for ISH (OR 1.05, 95%CI 0.95–1.16, p = 0.358). Moreover, smoking was significantly associated with IDH (OR 1.36, 95%CI 1.04–1.78, p = 0.026) but not with ISH (OR 1.04, 95%CI 0.90–1.21, p = 0.653).ConclusionsPatients with IDH were much younger, and the prevalence decreased with aging. BMI and smoking were remarkably associated with IDH rather than ISH. Keeping fit and giving up smoking might be particularly efficient in the management of young patients with IDH.Trial registrationNCT03862183, retrospectively registered on March 5, 2019.