Mean Incidence Research Articles

Red Breast Syndrome—Where Has It Gone?

Background Red breast syndrome (RBS) has been noted in past literature as a possible complication of implant-based breast reconstruction (IBBR) with the use of acellular dermal matrices (ADMs). Since its first appearance in 2009, RBS has drawn growing medical attention with reported incidence ranging from 7%–9%. There has been a noted decrease in the emergence of RBS despite its inclusion among the analyzed complications in a number of studies. This systematic review aims to evaluate the trend in reported RBS incidence over time and appropriately determine an accurate incidence of RBS from reported literature since the emergence of the phenomena. Methods A systematic literature review was performed in July 2023 that analyzed the incidence of RBS among retrospective cohort studies on complication rates of IBBR with ADM. Patient demographics, RBS incidence rates, and all-cause complications were captured. The review was performed according to Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines and Methodological Index for Nonrandomized Studies criteria was used to assess study quality. Results From 2009 to 2023, a total of 48 studies (n = 6251) met inclusion criteria of which 35 studies from 2017 to 2023 were not already included in a prior systematic review (n = 5246). The mean incidence of RBS in the unreported studies was 2.88% with a weighted mean of 3.22%. Analysis of the trend in RBS over time shows an increasing reported incidence rate from 2009 with a peak in incidence between 2016 and 2017, followed by a steady decline through 2022. Twenty-six of the studies were published from 2016 to 2019. Conclusions The incidence of RBS among prior studies and systematic reviews has fluctuated significantly since its initial emergence in 2009. Reported incidence rates have been on the decline since 2018 with a true weighted incidence of 3.22% from analysis of recent reported studies. Potential causes for the decline in incidence include practice changes in ADM preparation, changes in the ADM brand used for IBBR, and improved categorization of RBS compared to cellulitis/infection. Despite more robust criteria for diagnosis, no consensus for management has yet been established.

Relationship between global warming and autism spectrum disorder from 1990 to 2019.

Despite mounting evidence linking neurological diseases with climate change, the link between autism spectrum disorder (ASD) and global warming has yet to be explored. To examine the relationship between the incidence of ASD and global warming from 1990 to 2019 and estimate the trajectory of ASD incidence from 2020 to 2100 globally. We extracted meteorological data from TerraClimate between 1990 and 2019. To estimate the association between global ASD incidence and temperature variation, we adopted a two-stage analysis strategy using a generalised additive regression model. Additionally, we projected future ASD incidence under four representative shared socioeconomic pathways (SSPs: 126, 245, 370 and 585) by bootstrapping. Between 1990 and 2019, the global mean incidence of ASD in children under 5 years old was 96.9 per 100 000. The incidence was higher in males (147.5) than in females (46.3). A 1.0 °C increase in the temperature variation was associated with a 3.0% increased risk of ASD incidence. The association was stronger in boys and children living in a low/low-middle sociodemographic index region, as well as in low-latitude areas. According to the SSP585 scenario, by 2100, the children living in regions between 10 and 20° latitude, particularly in Africa, will experience a 68.6% increase in ASD incidence if the association remains. However, the SSP126 scenario is expected to mitigate this increase, with a less than 10% increase in incidence across all latitudes. Our study highlights the association between climate change and ASD incidence worldwide. Prospective studies are warranted to confirm the association.

Incidence, diagnostics, therapeutic management and outcomes of paediatric intestinal pseudo-obstruction in the Netherlands: A 20-year retrospective cohort study.

To describe incidence, clinical course, diagnostic and therapeutic management and long-term follow-up of paediatric intestinal pseudo-obstruction (PIPO) in the Netherlands between 2000 and 2020. Multicenter, national, retrospective, observational study including patients aged <18 years diagnosed with PIPO and treated between 2000 and 2020 in Dutch academic medical centres. Outcomes included demographics, incidence, symptoms, diagnostic- and treatment methods used during follow-up, number of hospital admissions and mortality. Between 2000 and 2020, 43 children (median age 120 months, range 13 - 301, 54% female) were diagnosed with PIPO in the Netherlands. Mean incidence was 0.008/100,000/years (range 0/100 000-0.029/100 000). Twenty-six patients developed PIPO in the neonatal period. Initial symptoms were vomiting (n = 21/35, 60%) and abdominal distension (n = 14/35, 40%). Diagnostic strategies included imaging, manometry, histopathology, metabolic- and genetic screening, endoscopy and exploratory surgery. Treatment was divided in nutritional support, pharmacotherapy, colonic irrigation and surgical interventions, of which nutrition and surgery were the cornerstones for care. During the observed study period, the median number of hospital admissions was 22.5 (range 1-176) with a median of 157.5 days (range 3-840) during 20-year follow-up. Two patients (6%) died: one from sepsis and one due to a severe underlying neurological disease. Heterogeneity in diagnostic- en treatment methods existed between patients. PIPO is a rare, long-lasting complex disease requiring a high number of diagnostic and therapeutic interventions and hospital admissions. However, mortality rate is relatively low. Based on our results, we recommend centralization and standardization of care for this complex rare disease.

Studies on the Detection of Viruses Infecting Capsicum Species in the Northern Zone of Cross River State, Nigeria

The objective of this study was to determine the occurrence, detection, and geographical spread of viruses that infect pepper (Capsicum spp.) in six towns spanning two local government areas (Yala and Ogoja) in the northern zone of Cross River State. A total of 348 leaf samples from symptomatic and asymptomatic pepper plants were randomly collected from farmer's fields during a survey in 2023–2024. The samples were then preliminary tested using an antigen coated plate enzyme-linked immunosorbent assay (ACP-ELISA) with seven antibodies specific for ToLCV, Cowpea aphid borne mosaic virus (CABMV), Cucumber mosaic virus (CMV), Potato virus X (PVX), Tobacco mosaic virus (TMV), and Pepper veinal mottle virus (PVMV). The findings showed that the viruses that infect pepper in Yala had a high cumulative mean incidence, accounting for 56.9% (198 infected samples). Yache in Yala had the highest virus incidence at 90%, while Bansara in Ogoja had the lowest at 40%. At different rates, ToLCV, CMV, PVY, and PVMV were found in the samples; PVX, TMV, and CABMV were not found. The CMV virus was the most commonly discovered of them. Additionally, mixed infections between the viruses—between ToLCV and PVY in Yache and between CMV and PVMV in Bansara—were found. This is the first report on account of viruses found in pepper in the northern part of Cross River State. The findings show that the viruses that cause the infections are common and might potentially be a threat to the production of pepper in that region.

Epidemiology and prognosis of obstructive and non-obstructive hypertrophic cardiomyopathy in Finland: a nationwide cohort study

Abstract Background Hypertrophic cardiomyopathy (HCM) is an often hereditary myocardial disease. The Finnish population has a specific genetic background, which may influence and even predispose people to various hereditary diseases. Whilst advances in genetic testing and imaging techniques may have influenced the detection of HCM and associated subtypes, contemporary data on incidence and prevalence remain limited. Purpose This study aimed to evaluate the current trends in the incidence, prevalence, and prognosis of obstructive and non-obstructive HCM in a nationwide cohort in Finland. Methods A population-based registry study was conducted using data from Finnish nationwide healthcare registries (HILMO/avoHILMO) including individuals aged at least 12 years with recorded HCM diagnosis between 2000 and 2021. The incidence was calculated by dividing the number of newly diagnosed HCM patients by the Finnish background population. Furthermore, the mean incidence per age-group was calculated by dividing the sum of age-group specific incidences by the number of age groups. The date and cause of death were obtained from national registries (Statistics Finland). Mortality was computed by dividing the number of deaths by follow-up length. Patients were followed from 2014 to 2021, and incident cases were defined as new diagnoses after 2014. HCM cases were stratified into obstructive HCM and non-obstructive HCM based on ICD-10 codes I42.1 and I42.2, respectively. Results Among 5,834 documented patients with HCM, the overall mean incidence by age-group was 2.64/100,000, with incidence increasing with age, peaking in those aged ≥85 years (6.22/100,000 patient-years [PY]). Annual incidence of obstructive HCM decreased from 2.2 to 1.4/100,000 PY, while non-obstructive HCM increased from 4.6 to 5.4/100,000 PY between 2014 and 2021 (Fig 1). Prevalence of non-obstructive HCM rose from 40 to 56/100,000 PY, while obstructive HCM prevalence remained stable (23-24/100,000 PY). All-cause mortality was 5.5/100 PY, with obstructive and non-obstructive HCM mortality at 5.7 and 4.6/100 PY, respectively. HCM-specific deaths accounted for 16% and 12% of all deaths in patients with non-obstructive and obstructive HCM, respectively. Conclusions This nationwide study in Finland revealed an increasing incidence and prevalence of non-obstructive HCM over time, contrasting with stable rates among patients with obstructive HCM. Incidence and prevalence were strongly age dependent. Non-HCM-related deaths were predominant in both HCM subtypes.

Biological effects of radiation exposure in patients treated with X-ray guided endovascular aortic repair

Abstract Background X-ray guided cardiovascular interventions such as endovascular aortic repair (EVAR) expose patients and operators to significant amounts of repeated ionising radiation over a long period of time. The biological effect of such protracted radiation exposure is poorly understood. We have previously demonstrated a higher incidence of dicentric chromosome (DC) aberrations in high-volume endovascular interventionalists and differences in acute DNA damage in lymphocytes between individuals following in vitro irradiation. Studies suggested a higher incidence of cancer in patients who underwent EVAR compared with those who have had open aneurysm repair, but the evidence is inconclusive. Further work is required to evaluate the biological radiation risk of X-ray guided cardiovascular interventions. Purposes We aimed to examine radiation-induced genome instability from patients after complex EVAR. We also aimed to investigate the intrinsic response of each patient to radiation using biomarkers of acute DNA damage following in vitro irradiation of their blood and to correlate this response to the expression of radiation-responsive genes. Methods Lymphocytes were isolated from patients after complex (branched/fenestrated) EVAR and non-irradiated controls. DC, a type of chromosomal aberration caused by radiation exposure were enumerated. γ-H2AX, a marker of acute DNA damage/repair, was measured by immunofluorescence after in vitro irradiation at 0.2 Gy and 1 Gy, along with the expression of the radiation-responsive genes FDXR, CCNG1, P21 and PHPT1 using qPCR. Results 17 patients (82% male, median age 73[59 – 85years]) and 16 controls (56% male, median age 68[53 – 83years]) were recruited. The mean incidence of DC was 3.782 (95% CI 3.13 - 4.43) and 0.898 (95% CI 0.48 -1.32) per 1000 cells for patients and controls, respectively (P&amp;lt;0.0001). Patients had higher background of γ-H2AX foci than unexposed controls, (0.7056, 95% CI 0.316 - 1.10) vs (0.241 95% CI 0.077 - 0.405) per cell, P&amp;lt;0.05. FDXR expression was most increased following irradiation (P&amp;lt;0.0001), reaching a mean 13.1-fold and 11.4-fold increase at 4-hour and 24-hour time-point, respectively, but this upregulation was not significantly different between the two groups. Conclusion We have shown an increased frequency of chromosomal aberrations in patients after complex EVAR, a biological finding that may support a propensity to developing malignancies. Patients also have higher basal DNA damage/repair (γ-H2AX) activity. Expression of ferredoxin reductase, FDXR gene could be a potential radio-responsive biomarker to provide personalised biological dosimetry information for clinical monitoring. Our study further underlines the long-term radiation risk of X-ray guided cardiovascular interventions and the potential of biological assays that may guide personalised care.

Evaluating XGBoost’s predictive accuracy on surgical site Infections in cardiac surgery

Abstract Background Surgical site infections (SSIs) pose a significant threat in cardiac surgery (CS), profoundly impacting patient prognosis. SSI incidence varies widely, reported between 3.5% and 26.8%. The study used a decade-long dataset from SSI surveillance in a specialized hospital in Italy, applying machine learning (ML) techniques to predict the SSI incidence among CS patients. Methods Data collected from 2013-2023 through the surveillance system of SSI in patients undergoing CS were used to train a predictive ML algorithm (XGBoost). Data included information on demographics, risk factors, surgery variables (incision site, prophylaxis, etc.), and the infection outcome derived from follow-up interviews at 30 days post-surgery, or 90 days for patients with prosthetic materials, according to the ECDC case definition of SSI. We used the R libraries “caret”, “smotefamily” and “xgboost” to train the algorithm. A train-test split of 70-30 was applied. Both downsampling of the majority class (no SSI) and oversampling of SSI cases with SMOTE were used in the training set to address class imbalance. Results A total of 10,534 subjects (65.9% males, mean age 68.3 years) who underwent CS (64.3% with prosthetic materials) were included, among which 533 SSIs were identified (mean incidence of 5.06%), with 430 cases (80.7%) occurring after discharge (38.7% deep SSI) and 103 (19.3%) before discharge (55.5% deep SSI). The trained XGBoost algorithm achieved an AUC of 0.62, sensitivity of 69%, and specificity of 50% in the prediction of SSI on the test dataset. Conclusions These findings suggest that while the XGBoost model provides a fair predictive capability, there is significant room for improvement in sensitivity and specificity. The use of artificial intelligence offers a promising opportunity to identify patients at risk of SSI. However, further research and comprehensive data are needed to refine the predictive model and effectively improve prevention measures. Key messages • Predominantly occurring post-discharge, SSIs in cardiac surgery necessitate enhanced prevention strategies, highlighting the critical phase after hospital discharge where surveillance is paramount. • Artificial intelligence may enhance post-discharge SSI surveillance, promising to identify patients at increased risk. Further research is needed to refine these AI tools for optimal sensitivity.

Incidence and trend of cardiac events among children and young adults exposed to psychopharmacological treatment (2006-2018): A nationwide register-based study.

The aim of this study was to assess cardiac event incidence and trends by sex and age in young patients on psychopharmacological treatment in Sweden. This nationwide incidence study encompassed data from Swedish registers (2006-2018). Patients aged 5-30 years were exposed to one or more psychotropic medications (attention deficit hyperactivity disorder medications, antihistamines, selective serotonin reuptake inhibitors, other antidepressants, anxiolytics, antipsychotics, hypnotics/sedatives). Annual incidences, trends and mean incidences of cardiac events (cardiac arrest, arrhythmias, fainting/collapse, sudden death) and recurrent events were calculated. Among those exposed (n = 875 430, 2 647 957 patient-years, 55% female), 26 750 cardiac events were identified. The mean annual incidence of cardiac events and first-ever events were 0.99% and 0.80%, respectively, showing significant upward annual trends of 4.26% and 2.48%, respectively (P< .001). The highest incidences were among females aged 15-19 years (1.50%) and those exposed to polypharmacy (1.63%), anxiolytics (1.53%) or antihistamines (1.27%). The mean annual incidences of cardiac arrest and arrythmias, for both sexes, were 0.01% and 0.51%, respectively. Fainting/collapse accounted for about half of all events, occurring more often in females. The pattern of rising annual incidence remained after excluding fainting/collapse. In all, 21.1% of events were recurrent. Death, including sudden death, occurred in 13 patients. The mean annual incidence of cardiac events among young patients receiving psychopharmacological treatment was low, 0.99%, with an upward trend of 4.26% annually. Incidence was highest in adolescent females and patients exposed to polypharmacy. Our study highlights the need for more knowledge regarding the possible association between exposure to psychopharmacological treatment and cardiac events.

Impact of the COVID-19 pandemic on the incidence of cardiometabolic risk factors among workers: results from the Japan Epidemiology Collaboration on Occupational Health study

BackgroundThe COVID-19 pandemic and associated restrictions on human activities have greatly changed lifestyles, which might have deteriorated the cardiometabolic profile.ObjectiveThis study aimed to examine the effect of the COVID-19 pandemic...

Behaviour, biochemical and histological responses of the freshwater mussels Unio ravoisieri exposed to wastewater from Wadi Guenniche (Northeastern Tunisia)

ABSTRACT Wastewater effluents increase contaminant levels in the aquatic environment, leading to various disruptive effects. In this study, responses of Unio ravoisieri transplanted into wastewater from Wadi Guenniche were monitored using filtration rate, oxidative stress, lipo-peroxidation, neurotoxicity and histopathological markers. The filtration rate was significantly increased by exposure to diluted wastewater, rising from 35.13 mg indiv−1 h−1 in the control to 63.49 mg indiv−1 h−1 in the mussels after 96 h of exposure. In contrast, this exposure significantly reduces catalase, glutathione-S-transferase and acetylcholinesterase activities in both organs. This decrease is dependent on the effluent concentration and time exposure. The malondihaldehyde content showed an increasing profile in both organs. It is only in the gills that this increase is significant for mussels transplanted in situ for 48 h. Contamination by wastewater causes histopathological changes in both organs, marked by infiltration, vacuolisation, secretion of lipofuscins and cell necrosis. The intensity of these lesions depends on the duration of exposure and the degree of pollution. The mean incidence of lesions increases depending on effluent concentration and exposure time in both organs. Our study contributes to the database on behavioural, biochemical and histopathological effects in mussels following the discharge of wastewater effluent into a freshwater ecosystem.

What Explains Hop Growers' Fungicide Use Intensity and Management Costs in Response to Powdery Mildew?

Methods for causal inference from observational data are common in human disease epidemiology and social sciences but are used relatively little in plant pathology. We draw upon an extensive data set of the incidence of hop plants with powdery mildew (caused by Podosphaera macularis) collected from yards in Oregon from 2014 to 2017 and associated metadata on grower cultural practices, cultivar susceptibility to powdery mildew, and pesticide application records to understand variation in and causes of growers' fungicide use and associated costs. An instrumental causal forest model identified growers' spring pruning thoroughness, cultivar susceptibility to two of the dominant pathogenic races of P. macularis, network centrality of yards during May-June and June-July time transitions, and the initial strain of the fungus detected as important variables determining the number of pesticide active constituents applied by growers and the associated costs they incurred in response to powdery mildew. Exposure-response function models fit after covariate weighting indicated that both the number of pesticide active constituents applied and their associated costs scaled linearly with the seasonal mean incidence of plants with powdery mildew. Although the causes of pesticide use intensity are multifaceted, biological and production factors collectively influence the incidence of powdery mildew, which has a direct exposure-response relationship with the number of pesticide active constituents that growers apply and their costs. Our analyses point to several potential strategies for reducing pesticide use and costs for management of powdery mildew on hop. We also highlight the utility of these methods for causal inference in observational studies.

Incidence of Type 1 Diabetes in Children Aged 0-14 Years in Trentino-Alto Adige Region and Determinants of Onset with Ketoacidosis.

To assess the incidence and the temporal trend of type 1 diabetes (T1D) and diabetic ketoacidosis (DKA) during the period 2014-2023 in youths aged 0-14 years in the Trentino-Alto Adige region, Italy. A retrospective review of all incident cases of T1D diagnosed at the two Pediatric Diabetes Centers of Bolzano and Trento was matched with diabetes exemptions (No. 344). Demographic, clinical, and socioeconomic status (SES) data at first hospitalization were collected from subjects who agreed to participate (No. 272). The incidence of T1D was 21.5/100,000 person/years, with a peak of 31.1 in 2021 during the COVID-19 pandemic. The mean age at the onset was 8.8 ± 3.9 years. Seventy-nine percent of the subjects were Italians, primarily residents in rural areas, and SES was equally represented. The mean incidence of DKA was 36.9%. The logistic regression analysis showed that the independent characteristics of the patients with DKA were of a younger age and displayed higher glycated hemoglobin (HbA1c) values. No relation of DKA with seasonality, ethnicity, or first-degree relative (FDR) with T1D or SES was detected. Our study revealed an incidence of T1D in the Trentino-Alto Adige region comparable to other areas in the North of Italy. The DKA rate negatively correlated with age; therefore, targeted prevention educational campaigns to increase awareness are needed.

Destructive fungal disease survey of common bean (Phaseolus vulgaris L.) rust (Uromyces appendiculatus) in Southern Ethiopia

Common bean (Phaseolus vulgaris L.) is important legume crop world-wide and in Ethiopia for its multipurpose uses. Common bean rust, is the most destructive fungal disease that severely reduces bean yield. For years, rust appeared in a farmer's field in Southern Ethiopia; however, the disease's significance remains unclear. The research aimed to ascertain the distribution and intensity of common bean rust, as well as elucidate the association of biophysical parameters. The field survey was conducted in southern Ethiopia in 2022. Ninety percent of the 78 commonbean fields were affected by common bean rust. Mareko, Meskan, Duguna Fango, Damot Woide, and Demba Gofa had 100% of the fields affected, and Boricha had 90%. Damot Woide and Lanfuro had the highest and lowest mean rust incidence rates, respectively, 59.2% and 22.5%. Duguna Fango had the highest rust severity (35.5%), while Lanfuro had the lowest (13.5%). In the research areas, the biophysical factors, either alone or in combination, have a significant impact on the intensity of common bean rust. The current investigation verified the distributionand the association biophysical factors with common bean rust. In addition, the survey of the disease and the identification of factors should continue over time and space.

Assessment of Fusarium wilt (Fusarium oxysporum f.sp. sesami) Disease Incidence in Sesame (Sesamum indicum L.) in Western Tigray, Northern Ethiopia

Fusarium wilt disease is one of the most serious diseases threatening sesame production in Tigray, northern Ethiopia. The aim of the present study was to assess Fusarium wilt disease incidence and its association with agronomic practices and environmental factors. Field survey was conducted in Kafta-Humera, Welkayt and Tsegedie districts in 2018 cropping season. A total of 92 farmers’ fields were assessed for the prevalence and incidence of the disease. Results indicated that 67% of farmers’ fields were infected by Fusarium wilt disease from the total assessed fields. Fusarium wilt disease incidence was varied from 0.22% to 80%. It was ranged from 0-72% in Kafta-Humera, 0-56% in Welkayt and 0-80% in Tsegedie. The mean disease incidence was 11.89% at Kafta-Humera, 11.14% at Welkayt and 10.69% at Tsegedie. According to the single predictor in the logistic regression model Fusarium wilt disease incidence was most affected significantly (p &lt; 0.05) with the previous crop and altitude. Higher levels of disease incidence were recorded when the previous crop was sesame, lower altitudes and in clay loam soil texture. Overall results of the present study indicated that Fusarium wilt disease is the major challenge to sesame production in study areas. Therefore, efforts should be put in place to manage the disease via integration of appropriate strategies.

Temporal Trends in the Epidemiology of Lower Back Pain in the United States.

This was an observational study. This study aims to explore sociodemographic and regional geographic variations in Lower back pain (LBP) incidence, prevalence, and burden in the United States (US from 2000-2019. LBP is a major contributor to lost wages and disability in the US. As LBP is associated with increasing age and sedentary lifestyle, the incidence of LBP is expected to rise. Due to LBP's multifactorial causes, US epidemiological trends lack sufficient data. Descriptive epidemiological data including disability-adjusted life years (DALYs), incidence, and prevalence per 100,000 population from 2000-2019 were collected from the Global Burden of Disease database. State-level data regarding poverty, insurance and employment status were obtained from the US Government Census Bureau and US Department of Labor. Statistical significance was indicated by P<0.05. From 2000-2019, the US demonstrated reductions in LBP incidence, prevalence, and DALYs. Regional analysis demonstrated the Midwest to have the greatest mean incidence, prevalence, and DALYs; with Midwestern females significantly more affected than females in other regions. Those aged 25-49 in the Midwest were impacted significantly more across all measures compared to age-matched populations in other regions. Nationally, there were no significant associations between unemployment and LBP. Poverty was inversely correlated with LBP incidence. Uninsured status was positively correlated with prevalence and DALYs. Although there has been progress in reducing the impact of LBP in the US, the Midwest region has greater rates for all measures compared to other US regions. Further, females and those aged 25-49 in the Midwest were more likely to be affected by LBP compared to counterparts in other regions. Future studies should identify specific factors contributing to elevated LBP rates in the Midwest in order to guide targeted interventions to reduce the incidence and burden of LBP there.

Prevalence of Juvenile-Onset and Pediatric Huntington's Disease and Their Availability and Ability to Participate in Trials: A Dutch Population and Enroll-HD Observational Study.

Juvenile-onset Huntington's disease (JHD) represents 1-5% of Huntington's disease (HD) patients, with onset before the age of 21. Pediatric HD (PHD) relates to a proportion of JHD patients that is still under 18 years of age. So far, both populations have been excluded from interventional trials. Describe the prevalence and incidence of JHD and PHD in the Netherlands and explore their ability to participate in interventional trials. The prevalence and incidence of PHD and JHD patients in the Netherlands were analyzed. In addition, we explored proportions of JHD patients diagnosed at pediatric versus adult age, their diagnostic delay, and functional and modelled (CAP100) disease stage in JHD and adult-onset HD patients at diagnosis. The prevalence of JHD and PHD relative to the total manifest HD population in January 2024 was between 0.84-1.25% and 0.09-0.14% respectively. The mean incidence of JHD patients being diagnosed was between 0.85-1.28 per 1000 patient years and of PHD 0.14 per 1.000.000 under-aged person years. 55% of JHD cases received a clinical diagnosis on adult age. At diagnosis, the majority of JHD patients was functionally compromised and adolescent-onset JHD patients were significantly less independent compared to adult-onset HD patients. In the Netherlands, the epidemiology of JHD and PHD is lower than previously suggested. More than half of JHD cases are not eligible for trials in the PHD population. Furthermore, higher functional dependency in JHD patients influences their ability to participate in trials. Lastly, certain UHDRS functional assessments and the CAP100 score do not seem appropriate for this particular group.

Changes in Incidence of Cirrhotic and Noncirrhotic Hepatocellular Carcinoma in the United States

IntroductionHepatocellular carcinoma (HCC) occurs most often in a background of cirrhosis. Patients with noncirrhotic HCC represent a distinct population, which has been characterized in single-center studies, but has not been fully evaluated on a population level in the United States. Materials and methodsHCC cases from Surveillance, Epidemiology, and End-Results diagnosed between 2000 and 2020 were categorized as cirrhotic or noncirrhotic. Clinical and pathologic factors, age-adjusted incidence rates (AAIR), and the overall HCC-specific survival were compared between groups. ResultsThere were 18,592 patients with cirrhosis (80.4%) and 4545 without (19.6%). AAIRs for noncirrhotic HCC remained relatively unchanged from 2010 to 2020, with a mean incidence of 0.35 per 100,000. The AAIR for cirrhotic HCC declined from 1.59 to 0.85 per 100,000 during the same period. Patients with cirrhosis were younger (median age 62 versus 65 y, P < 0.001). Patients without cirrhosis, compared to those with cirrhosis, were less likely to have elevated alpha fetoprotein (53.9% versus 62.0%, P < 0.001), had larger tumors (median tumor size 5.0 versus 3.5 cm, P < 0.001), presented more frequently with localized disease (59.9% versus 55.8%, P < 0.001), were more likely to undergo surgery (OR 2.21, 95% CI 2.07-2.36), and had better HCC-specific survival (median 40 versus 27 mo, P < 0.001). ConclusionsThe relative increase in the proportion of noncirrhotic HCC in the Untied States may be due to a decline in the incidence of cirrhotic HCC. Patients with noncirrhotic HCC have larger tumors, are more likely to undergo surgical resection, and have improved cancer-specific survival.

Pulmonary rehabilitation with balance training for fall reduction in chronic obstructive pulmonary disease: a randomized controlled trial

Background and objectivesAvailable evidence suggests that adults with chronic obstructive pulmonary disease (COPD) performed substantially worse than healthy controls on many balance measures and balance training can improve the balance measures in this population. We conducted this study to determine the effects of incorporating balance training into pulmonary rehabilitation (PR) on the incidence of falls at 12 months follow-up in high fall risk adults with COPD.MethodsWe conducted a prospective international multi-center randomized controlled trial. Eligible participants were adults with COPD at a high risk of future falls and were randomly assigned (1:1) to the intervention or control group. The intervention included personalized balance training for a targeted total of 90 min per week. Both the intervention and control groups received usual PR (2–3 times per week for 8–12 weeks). The primary outcome was the incidence of falls at 12-month follow-up using monthly fall diary calendars. Negative binomial regression or recurrent events models were used to examine the effects of the intervention on fall events. Multiple imputations were performed to deal with missing values.ResultsOf 258 participants who were enrolled in the trial, 178 provided falls information (intervention group = 91, control group = 87) and were included in the main analysis. Forty-one participants (45%) experienced at least one fall event in the intervention group and 33 (38%) in the control group (p = 0.34). The mean incidence of falls at 12 months was similar between the two groups (128 versus 128 per 100 person-years; mean difference: 0.30, 95% CI: -0.76 to 1.36 per 100 person-years). The results are robust after multiple imputations for missing data (n = 67).ConclusionsPR incorporating balance training compared to PR alone did not reduce the incidence of falls over the 12-month period in high fall risk adults with COPD.Trial registrationThe study was registered with ClinicalTrials.gov (NCT02995681) on 14/12/2016.

A clinical comparison of glycol and water-based heater-cooler systems for cardiopulmonary bypass.

While newer heater-cooler technologies using ethylene glycol-based (GB) solutions during cardiothoracic surgery have become commercially available, there is a paucity of clinical data describing their effectiveness during cardiopulmonary bypass (CPB) support. This analysis aimed to compare clinical characteristics and procedural outcomes using water-based (WB) and GB heater-cooler systems. A retrospective analysis was performed on consecutive adult patients undergoing CPB from June to October 2022 comparing WB or GB groups. The primary outcome was a composite of operative death or major morbidity. Secondary endpoints included transfusion requirements on CPB, patient cooling and warming rates, and vasoactive-inotropic scores (VIS) at case completion. P-control charts were used to monitor the weekly incidence of the composite outcome. A sub-analysis was performed to evaluate the primary outcome for cardiac surgery cases indexed by the Society of Thoracic Surgeons (STS). There were 167 patients included for analysis; 87 (52.1%) underwent CPB with a WB system and 80 (47.9%) with a GB system. GB procedure subjects were younger (p = .01), experienced longer CPB times (p = .034), and were more likely to receive thoracic transplant or aortic surgery (p = 0.015). The composite outcome of operative mortality or major morbidity occurred in 29.9% and 24% of the WB and GB groups, respectively (p = .372). P-control charts indicated a weekly mean incidence of 30% during WB practice, which decreased to 24% with GB practice. Among 106 STS-indexed cardiac surgery cases, mean composite outcome incidence decreased from 19% to 6% following our GB transition. Additionally, cooling, and warming rates indexed to patient BSA and VIS at case completion were not significantly different. Our analysis demonstrated a safe transition from WB to GB heater-cooler technologies in our practice. This early analysis suggests that GB heater coolers may be safely adopted to mitigate the risks of nontuberculous mycobacterium infections for cardiac surgical patients.

Influence of Weather Conditions and the Aphid Population on the Potato Virus Y Infection of Tobacco in the Field

Potato virus Y (PVY) is a major tobacco (Nicotiana tabacum L.) pathogen that causes severe crop losses. We studied the influence of meteorological factors and a population of twelve aphid species on the development of PVY in field-grown tobacco from 1996 to 2010 in Poland. Three PVY-susceptible tobacco varieties were used in the study. The mean virus incidence ranged from 18% in 2010 to almost 99% in 1996, 2004, and 2009. For determining the relationship between tobacco plant infection and meteorological conditions and aphid populations, logistic regression analysis was used. It was found that the probability of PVY infection is significantly dependent on the average air temperature, relative humidity, number of days with an average temperature of at least 25 °C, and the abundance of Aphis fabae and Brachycaudus helichrysi. The probability of infection of tobacco plants with potato virus Y decreased with increasing air temperature and relative humidity. In addition, with each subsequent day with a temperature of at least 25 °C, the risk of infection decreased by 24%. Furthermore, it was often observed that high populations of Aphis fabae and Brachycaudus helichrysi were associated with a high incidence of virus infection in tobacco plants.