Middle-aged Patients Research Articles

Identification of Metabolic Patterns in Korean Patients with Type 2 Diabetes Mellitus and their Association with Diabetes-Related Complications.

Resolving metabolic heterogeneity in patients with type 2 diabetes mellitus (T2DM) gives them access to precision medicine. Despite ethnic diversity in pathophysiological processes in individuals with T2DM, studies on subtypes of diabetes related to clinical characteristics in Asians are insufficient. This study aims to identify metabolic patterns in middle-aged patients with T2DM in Republic of Korea (Korea) and determine the incidence of diabetes-related complications according to patterns. We analyzed 6,603 patients with T2DM aged 30 to 64 who visited three centers of general hospital in Korea. Three metabolic patterns were derived: Obesity and Hypertension pattern (OH-P), Liver Function-related HyperGlycemia pattern (LFHG-P), and Decreased Kidney Function pattern (DKF-P). The highest tertile of the OH-P score was associated with an increased risk of peripheral vascular disease compared to the lowest tertile (HR = 1.26, 95% CI = 1.02-1.57). The highest tertile of the LFHG-P score was associated with an increased risk of myocardial infarction (HR = 1.79, 95% CI = 1.13-2.82) and atrial fibrillation (HR = 1.54, 95% CI = 1.07-2.23). No association with complications was found in the DKF-P. This study suggests the need for proper management and treatment according to metabolic patterns in patients with T2DM.

Abstract 4138794: Risk Factors of Cumulative Limb Amputation in Patients with Thromboangiitis Obliterans (Buerger's Disease): Insights from Nationwide Inpatient Sample

Background: Thromboangiitis obliterans (TAO) is a rare, nonatherosclerotic, inflammatory disease that typically onsets in male patients at young age with heavy smoking. TAO commonly affects small and medium-sized arteries in extremities, and up to 1/3 of patients with TAO will experience limb amputation. However, the role of social determinants of health (SDoH) are not well studied in TAO patients with limb amputation in a real-world dataset. Methods: A cross-sectional study was performed in Nationwide Inpatient Sample (NIS) of United States, from calendar year 2016-2021. The diagnosis of diseases was identified by ICD-10-CM codes. Univariable logistic regression analysis was performed to identify characteristics associated with cumulative limb amputation (CLA). Stepwise multivariate logistic regression model was further employed to analyze association between significant characteristics and CLA. Results: In this study, 33.3% (N=432) patients with TAO (N=1297) had CLA. Variables showed significant association with CLA identified by univariable analysis were further included in stepwise multivariate logistic regression model. In the multivariate model, middle-age patients had higher risk of CLA than young patients (OR=1.41, 95% CI=1.00-1.99, p=0.050). Female showed lower CLA risk than male patients (OR=0.53, 95% CI=0.41-0.69, p<0.001). Black patients showed higher CLA risk than White (OR=1.82, 95% CI=1.24-2.68, p=0.002). Compared to Medicare insurance, self-pay (OR=0.51, 95% CI=0.30-0.87, p=0.014) and Private insurance (OR=0.69, 95% CI=0.49-0.97, p=0.035) patients had lower CLA risk. Higher socioeconomic status associated with lower CLA risk, and patients in the 3 rd percentile had significantly lower CLA risk than those in the 1 st percentile (OR=0.68, 95% CI=0.49-0.95, p=0.028). Patients with tobacco smoking showed higher CLA risk (OR=2.11, 95% CI=2.49-3.00, p<0.001). Conclusions: The CLA rate was up to 33.3% among the TAO patients in NIS 2016-2021. SDoH like age, sex, race, insurance type and socioeconomic status showed significant association with CLA risk in TAO patients. Further studies are warranted to explore mechanism, health equity and multidisciplinary care to decrease CLA for patients with TAO.

Abstract 4140119: Liver Steatosis and Liver Fibrosis Predict Major Adverse Cardiovascular Events in the CLEAR Outcomes Trial

Background: Metabolic dysfunction-associated steatotic liver disease (MASLD), and progressive stages accompanied by liver fibrosis (LF), have been associated with liver-related and CV complications in middle-aged patients, although data on the latter is limited. Objectives: We evaluated whether liver steatosis (LS) or LF are associated with CV outcomes in a large clinical trial that included patients at high CV risk who were statin intolerant (SI), and if so, whether bempedoic acid (BA) treatment reduces observed increases in CV risk. Methods: CLEAR Outcomes evaluated the efficacy of BA in 13,970 SI patients randomized to BA (180 mg daily) or placebo and followed for a median of 40.6 months. The primary outcome was a 4-component major adverse CV event (MACE4: nonfatal MI, nonfatal stroke, coronary revascularization, or CV death). This post-hoc analysis used the following non-invasive algorithms to estimate the presence of LS and LF at baseline: Framingham Steatosis Index (FSI), Fibrosis-4 Index (FIB-4) and NAFLD Fibrosis Score (NFS). Continuous variables were reported as mean±SD, categorical variables as proportion. Time-to-event data were analysed using a Cox proportional hazards model. Adjusted hazard ratios (aHR) for every 1 unit increase in score, while holding every other variable constant, and corresponding 95% CI were reported. Results: The mean age of included participants was 66±9 years, 48% were female, mean BMI was 30±5 kg/m 2 , and characteristics were balanced over the treatment arms. Baseline FSI was 0.2±1.5, FIB-4 1.3±0.6 and NFS -0.6±1.2. LS was associated with an increased incidence of MACE4 in the whole study population, as indicated by the aHR of 1.09 (1.06-1.12) for 1 unit of FSI increase. LF was also associated with increased risk of MACE4 in the overall population, aHR 1.19 (1.11-1.28) for 1 unit of FIB-4 increase, and aHR 1.14 (1.10-1.19) for 1 unit of NFS increase. For LS, per 1 unit of FSI increase the aHR for MACE4 was lower in the treatment group: aHR of 1.04 (0.99-1.09) for BA vs 1.14 (1.09-1.18) for placebo, interaction p=0.004. For LF, aHR did not differ between groups and no significant interaction with treatment was observed. Conclusion: Both LS and LF are associated with an increased risk of MACE4. Overall, BA was associated with lower rates of MACE4 across categories of LS and LF (data not shown). A lower risk of LS-associated MACE4 was observed in the BA group. These benefits are less clear regarding the MACE4 risk driven by LF.

A PATIENT WITH OSTEOARTHRITIS AND HYPERTENSION IN GENERAL MEDICAL PRACTICE

Osteoarthritis is one of the most common diseases in Ukraine and worldwide, often leading to early disability in people of working age, making it both a medical and social concern. According to the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis, and Musculoskeletal Diseases, as well as the International Society for the Study of Osteoarthritis, it is known that a middle-aged patient with osteoarthritis typically has four accompanying pathologies. In elderly patients, in addition to osteoarthritis, up to eight other chronic conditions are often diagnosed. Comorbidity is frequently observed in middle-aged patients with osteoarthritis. Understanding the pathogenetic links between osteoarthritis and comorbid conditions plays an important role in the timely diagnosis and treatment of these diseases, helping to maintain a high quality of life for patients. Objevtive: the study of the pathogenesis of osteoarthritis and arterial hypertension, along with the proposed therapy for treating comorbidities in patients with both osteoarthritis and arterial hypertension, aims to enhance the treatment outcomes. Materials and methods. Analytical and bibliosemantic methods were used in this study. During the scientific search, 38 modern literature sources were reviewed and analyzed concerning the pathogenetic impact on the development of osteoarthritis and arterial hypertension, as well as their shared mechanisms in the development and progression of both conditions. The study was carried out at the Department of Family Medicine and Therapy of the Regional Rheumatology Center, M. V. Sklifosovsky Poltava Regional Hospital. A total of 50 people were examined; the main group consisted of 35 individuals with stage II hypertension, grade 2, combined with stage II knee osteoarthritis (according to the Kellgren-Lawrence scale), with joint dysfunction of stages 1-2. These patients were aged 40-65 years (mean age 51.8±2.14 years). The duration of hypertension was 10.07±1.24 years, and the duration of manifested osteoarthritis was 8.56±1.03 years. The comparison group consisted of 20 individuals with stage II, grade 2 hypertension (mean age 52.5±2.38 years), with a mean hypertension duration of 11.31±1.17 years. The clinical diagnosis of osteoarthritis was established according to the recommendations of the European Alliance of Associations for Rheumatology (2018). The diagnoses of comorbid conditions were confirmed in accordance with relevant orders from the Ministry of Health of Ukraine, with verification by specialized experts. Patients with osteoarthritis received standard treatment, and, when necessary, additional treatment for comorbid conditions was prescribed (a hypotensive combination of an ACE inhibitor and long-acting calcium. Results: The presence of osteoarthritis exerts an additional negative impact on heart rate variability in patients with hypertension. The reduction of the Low Frequency/High Frequency (LF/HF) index due to the use of this therapy (a combination of an ACE inhibitor and a long-acting calcium antagonist in doses of 4/5 mg, 4/10 mg, 8/5 mg, 8/10 mg) in the treatment of patients with comorbidity of hypertension and osteoarthritis contributes to the activation of the sympathetic nervous system, reduction of patient mortality, balancing of the nervous system by inhibiting sympathetic nervous tone, and lowering high blood pressure. Conclusions: The proposed combination therapy for patients with osteoarthritis and hypertension contributes to prolong remission of both the primary disease and comorbid conditions, reduces the frequency of hospitalizations, and shortens inpatient treatment by 3-4 days.

AGE-RELATED CHARACTERISTICS OF ISCHEMIC HEART DISEASE INCIDENCE IN UKRAINE: A TWO-CENTER STUDY

Purpose of this study is to investigate the age-related characteristics of the incidence of coronary heart disease in Ukraine, considering sex differences. Materials and Methods: The study included patients with coronary heart disease who underwent coronary artery bypass surgery on a beating heart (n = 3,674), comprising 3,061 males and 613 females. The average age of the participants was 60.6 ± 0.8 years. The analysis was based on data obtained from primary medical documentation, including medical histories, anamnestic information, and extracts from patients’ outpatient cards. The research design categorized participants by age group according to the World Health Organization age classification and by sex. Results: The article presents the incidence rates of coronary artery disease based on patient age groups, classified according to the World Health Organization, and sex. The distribution of patients by age groups was analyzed while considering sex, and the frequencies and average ages of the patients were determined. It was found that the incidence of coronary artery disease was highest among the most prevalent age groups in Ukraine's population: middle-aged and elderly patients. The frequency of early postoperative mortality was 0.6%, and it correlated with age-related incidence rates of coronary heart disease. Notably, early postoperative mortality was significantly higher in age groups with the highest incidence of coronary heart disease, specifically among middle-aged and elderly patients (p = 0.03, χ² = 4.69). Conclusions: In this retrospective two-center study of patients with coronary heart disease, it was determined that male patients were affected five times more frequently than female patients. The most common age groups for patients with coronary heart disease were identified as middle-aged and elderly. Early postoperative mortality following coronary artery bypass surgery on a beating heart was found to be 0.6%, with the highest rates observed in elderly (54.6%) and middle-aged (31.8%) patients. The frequency ratios demonstrated statistical significance favoring elderly patients (p = 0.03, χ² = 4.69). The frequency of early postoperative mortality was significantly higher among male patients (p = 0.0001, χ² = 40.33).

Colorectal carcinoma-induced iron deficiency anemia: A literature review and a case scenario

Colorectal carcinoma (CRC) is among the leading cancers worldwide and a major cause of cancer-related mortality. Iron deficiency anemia (IDA), resulting from inadequate iron for hemoglobin production, has been increasingly linked to CRC, often leading to misdiagnosis. This study reviews the clinicopathological associations of IDA in the context of colorectal cancer, using the medical records of a septuagenarian diagnosed with both conditions as a case study. Employing the Problem-Intervention-Comparison-Outcome model, we searched for “colorectal carcinoma” and “iron deficiency anemia” as keywords. CRC ranks among the top five cancers of global health importance, with socioeconomic factors, sedentary lifestyles, and dietary choices significantly influencing both conditions. Notably, IDA is particularly associated with the right-sided CRC in individuals over 40. Upregulation of interleukin-6 in CRC cells stimulates hepcidin release, which mediates anemia of chronic disorders and IDA. The case revealed right-sided signet ring cell CRC, microcytic hypochromic anemia, bone marrow metastasis, and low serum iron and ferritin levels. This study highlights the need for increased suspicion of CRC in middle-aged and elderly patients presenting with recurrent IDA. Regular screening is essential for the early detection and improved treatment outcomes. While colonoscopy is the gold standard for prevention, its effectiveness in detecting early molecular links between neoplasia and chronic inflammation is limited. There is also no consensus on surveillance protocols, and many gastroenterologists do not adhere to recommended biopsy sampling practices. In conclusion, this study advocates for including complete blood count and iron studies as essential tests in guidelines for screening and diagnosis for CRC-related IDA to enhance diagnostic practices.

The impact of malignancy on death anxiety and psychological well-being in middle-aged and older patients undergoing abdominal surgery: a quasi-experimental study.

Malignancy is a critical factor affecting death anxiety and psychological well-being. This study examined the impact of malignancy on death anxiety and psychological well-being in middle-aged and older adult patients undergoing abdominal surgery and projected it along with sociodemographic profiles. This study is quasi-experimental in design. It was conducted with patients undergoing abdominal surgery at a university hospital due to suspected malignancy. A total of 93 patients participated in the study: 57 patients diagnosed with malignancy were included in the experimental group, while 36 patients without a malignancy diagnosis were included in the control group. Data were collected using a questionnaire developed by the researchers based on the literature, the 'Turkish Death Anxiety Scale', and the 'Psychological Well-being Scale'. The analyses revealed that the data were normally distributed, and parametric tests were used to analyze differences between demographic variables and groups. Cohen's d and r values were examined to assess the effect size in the tests. The study found a significant difference in death anxiety between the experimental and control groups (P < 0.05), with higher mean scores in the experimental group. Malignancy had a large effect on death anxiety (d = 1.42). Additionally, the control group had significantly higher mean psychological well-being scores compared to the experimental group (P < 0.05). The study found that malignancy significantly affects death anxiety and psychological well-being. Increased death anxiety in patients with malignancy was associated with reduced psychological well-being. Thus, assessing death anxiety and providing targeted nursing care are essential for supporting the psychological well-being of these patients.

Mid-term efficacy of non-contact orthopedic robot navigation in the treatment of lumbar spondylolisthesis

ObjectiveThis study was aimed to explore the mid-term efficacy of non-contact orthopedic robot navigation in the treatment of lumbar spondylolisthesis.MethodsThe clinical data of young and middle-aged patients with lumbar spondylolisthesis were retrospectively analyzed and divided into an observation group and a control group according to surgical methods. The observation group was treated with minimally invasive transforaminal interbody fusion (MIS-TLIF) combined with orthopedic robot-navigated percutaneous pedicle screw fixation; while the control group underwent traditional posterior lumbar interbody fusion (PLIF). Perioperative indicators, waist and leg pain Visual Analog Scale (VAS) scores, Oswestry Disability Index (ODI), and complications were compared between groups.ResultsA total of 32 patients with lumbar spondylolisthesis were included in this study, with the average age of 50.3 ± 2.7 years old. There were 17 patients in the observation group and 15 patients in the control group. Although the new surgical technique for the observation group may require longer operative time, it showed significant advantages in reducing intraoperative bleeding, postoperative drainage, and shortening hospital stay. These benefits might result in faster recovery for patients, reduced risk of complications, and improved overall quality of life. The new technology was also significantly better compared to the traditional method in terms of VAS scores and ODI at 1 week, 1 month, 3 months, and 6 months post-surgery. These results provided patients with better treatment options and potentially a faster path to recovery. One case with infectious incision in the observation group and one case with intraspinal hematoma formation in the control group were observed. However, there was no statistical difference in the complication rates between the two groups (P > 0.05).ConclusionThe non-contact orthopedic robot navigation for the treatment of lumbar spondylolisthesis was demonstrated to be minimally invasive, precise, and stable surgical method. It is a treatment option worth considering for suitable patients.

Clinical characteristics and bloodstream infection pathogens by gram-negative bacteria in different aged adults: A retrospective study.

This study aims to determine the characteristics and distribution of pathogenic bacteria in bloodstream infections (BSIs) by gram-negative bacteria in adults. One hundred seventy-one adult patients with BSIs who were treated at the Affiliated Hospital of Chengde Medical College between January 2018 and January 2020 were included in this study. The patients were assigned to the young- and middle-aged group and elderly group based on age. General patient data were analyzed. More elderly patients had BSIs and gram-negative bacteria than young- and middle-aged patients. The incidence of underlying diseases in elderly patients was significantly higher than the young- and middle-aged patients (P < .01). The composition of Brucella spp. was significantly different between the elderly group and young- and middle-aged group (P < .05). There were significantly more gallbladder infections in the elderly group than the young- and middle-aged group, and significantly fewer elderly patients had no definite infection sites than the young- and middle-aged group (P < .05). The incidence of complications and in-hospital mortality in the elderly group was higher than the young- and middle-aged group (P < .05). BSIs caused by gram-negative bacteria mainly involved elderly patients. BSIs were characterized by complications and a poor prognosis, as well as pathogenic bacteria and primary infection sites.

Xanthogranulomatous pyelonephritis in a child with autoimmune joint disease.

Xanthogranulomatous pyelonephritis is a rare condition in paediatric patients, mostly described in middle-aged female patients. We present a 7-year-old female with juvenile idiopathic arthritis, who was found to have a kidney mass with a concurrent Escherichia coli urinary tract infection. Surgical excision was done out of concern for possible malignancy. Histology confirmed the diagnosis of xanthogranulomatous pyelonephritis and persistent E. coli infection.

Too Many Couch Potatoes Among Middle-Aged Inflammatory Bowel Disease Patients: Findings from the “BE-FIT-IBD-2” Study

Background: Regular physical activity (PA) is desirable, regardless of age, even in patients with chronic conditions such as inflammatory bowel disease (IBD). Aims: This study aims to assess PA levels and related barriers/facilitators in IBD patients, stratifying them into age groups (with a threshold of 50 years). Methods: The International PA Questionnaire (IPAQ) assessed PA levels regarding resting metabolic rate (Met) in minutes per week (min/wk). Patient-reported outcomes 2 (PRO-2) evaluated disease activity. Results: Among the 237 enrolled patients, PA rates were found to differ significantly in terms of patients being sufficiently active (55% vs. 39.8%), inactive (39.6% vs. 59.1%), and engaging in health-enhancing PA (5.4% vs. 1.1%) between patients under and at least 50 years old, respectively (p &lt; 0.001). Overall, PA levels followed this trend, being higher in younger patients [892 (446.5–1439) vs. 545.25 (257–1210.47) Met min/wk, p = 0.007]. Individuals aged at least 50 years tend to have lower PA at regression analysis (OR: 3.302, p = 0.018). Patients aged at least 50 years perceived IBD as more of a barrier to PA (p = 0.04). Bowel urgency is a significant barrier, especially in older patients (p = 0.022). Conclusions: Age is an unmodifiable factor impacting and influencing PA levels. Strategies to recover exercise levels in older IBD patients should be encouraged.

Integrated bagging-RF learning model for diabetes diagnosis in middle-aged and elderly population

As the population ages, the increase in the number of middle-aged and older adults with diabetes poses new challenges to the allocation of resources in the healthcare system. Developing accurate diabetes prediction models is a critical public health strategy to improve the efficient use of healthcare resources and ensure timely and effective treatment. In order to improve the identification of diabetes in middle-aged and older patients, a Bagging-RF model is proposed. In the study, two diabetes datasets on Kaggle were first preprocessed, including unique heat coding, outlier removal, and age screening, after which the data were categorized into three age groups, 50–60, 60–70, and 70–80, and balanced using the SMOTE technique. Then, the machine learning classifiers were trained using the Bagging-RF integrated model with eight other machine learning classifiers. Finally, the model’s performance was evaluated by accuracy, F1 score, and other metrics. The results showed that the Bagging-RF model outperformed the other eight machine learning classifiers, exhibiting 97.35%, 95.55%, 95.14% accuracy and 97.35%, 97.35%, 95.14% F1 Score at the Diabetes Prediction Dataset for diabetes prediction for the three age groups of 50–60, 60–70, and 70–80; and 97.03%, 94.90%, 93.70% accuracy and 97.03%, 94.90%, 93.70% F1 Score at the Diabetes Prediction Dataset. 95.55%, 95.13% F1 Score; and 97.03%, 94.90%, 93.70% accuracy; and 97.03%, 94.89%, 93.70% F1 Score at Diabetes Prediction Dataset. In addition, while other integrated learning models, such as ET, RF, Adaboost, and XGB, fail to outperform Bagging-RF, they also show excellent performance.

Molecular Insights and Pharmacotherapy of Diabetic Neuropathy

Background: Diabetes mellitus is a chronic disorder of energy metabolism caused by lack or decrease in the effectiveness of insulin, and is characterised by an abnormally elevated blood glucose concentrations and the development of macrovascular, microvascular and/or neuropathic complications. Diabetic neuropathy (DN) is one of the most debilitating outcomes of diabetes mellitus, and may cause pain, decreased mobility as well as amputation. Diabetes can damage the peripheral nervous system (PNS), through the induction of de-myelination in neurones, precipitated by chronic hyperglycaemia-induced oxidative stress, and causing a condition that involves the upper and lower limbs. Objective: The study discussed the risk factors for insulin resistance and pre-diabetes, type II diabetes mellitus and vascular complications, cellular and molecular basis of DN, physiopathological mechanisms, and the pharmacological treatment of DN. Method: The study examined journal articles and standard textbooks, as it relates to diabetes mellitus and its complications. Search for articles on DN was carried out in the literature. These were identified and reviewed for selection using chemical abstracts service, pubmed, google scholar, crossreference, web of science, pubmed central free article, and scopus. The key words used for search were: diabetic neuropathy; diabetic peripheral neuropathy; peripheral neuropathy; microvascular complications of diabetes mellitus; and neuromuscular complications of diabetes mellitus. Result &amp; Discussion: Two hundred and fifty (250) articles and other works were identified, while ninety-seven (97) articles and non-journal materials were extracted and reviewed, taking into account the criteria for selection. Studies done in the last 4.5 decades were included, while works written on other languages, outside English were excluded. Findings indicate that DN is a complex disorder that affects the peripheral and/or cranial nerves, which is caused by unattended or poorly attended, long-term increase in blood glucose concentrations. It relatively manifests early, affecting a significant proportion of the micro-blood vessels in the middle-aged and elderly diabetic patients. DN causes numbness, loss of sensation, and sometimes pain in the feet, legs, arms or hands. Hyperglycaemia causes the activation and inhibition of several molecular pathways that are crucial for homeostasis in neuronal and neuroglial cells. Conclusion: DN is the commonest complication of diabetes mellitus. It has no known definitive therapy. Treatment is essentially symptomatic with huge economic and psychological burden, hence the rationale for a cost effective and targeted therapies. Achieving euglycaemia using anti-diabetic regimens (i.e., insulin and oral hypoglycaemic agents), foot care, changes in feeding habits and lifestyle modification are critical to holistically address the problem.

Research Progress on the Treatment of Vascular Vertigo with Active Ingredients of Pueraria Lobata

Vascular vertigo is a common disease among middle-aged and elderly patients with vertigo, caused by cerebrovascular diseases, which seriously affects the quality of life of patients. Its pathogenesis is diverse, and there is still a lack of clear and effective therapeutic drugs in clinical practice. Pueraria lobata, as a commonly used traditional Chinese medicine for treating brain diseases, is widely used in clinical practice and has great development prospects. By summarizing the network pharmacology and clinical medication rules of vascular vertigo, it was found that Pueraria lobata is a high-frequency single traditional Chinese medicine for treating this disease. Modern pharmacological research has found that the main components of Pueraria lobata, such as isoflavones, triterpenes, coumarins, and alkaline compounds, can all play a preventive and therapeutic role in vascular dizziness. This article summarizes the published domestic and foreign papers and experiments, and takes the pathogenesis of vascular vertigo and the pharmacological characteristics of Pueraria lobata as a breakthrough point. Through sorting, it was found that Pueraria lobata exerts pharmacological effects in improving vascular endothelial function, regulating lipid metabolism, anticoagulation and antithrombotic effects, inhibiting oxidative stress, and regulating inflammatory reactions, and has significant effects on the clinical treatment of vascular vertigo.

The triglyceride-glucose index is a predictor for cardiovascular events and all-cause mortality in young and middle-aged patients with metabolic syndrome

Abstract Aims The association between the triglyceride-glucose (TyG) index and cardiovascular risk in young and middle-aged individuals with Metabolic syndrome (MetS) remains unclear. This study aimed to investigate the relationship between baseline TyG index and cardiovascular events and all-cause mortality in these patients among American adults. Methods This study enrolled 4937 young and middle-aged patients with MetS from the National Health and Nutrition Examination Survey (1999–2018). Mortality outcomes were determined by linking to National Death Index records up to December 31, 2019. Multivariate Cox proportional hazards models were constructed to analyze explore the associations between baseline TyG index and cardiovascular events or all-cause mortality. Non-linear correlations were explored using restricted cubic splines, and a two-piecewise Cox proportional hazards model for both sides of the inflection point was constructed. Results During the up to 9.3 years follow-up period, a total of 463 all-cause deaths and 143 cardiovascular events were recorded. The multivariate-adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) escalate from the lowest to the highest TyG index quartile. Specifically, for cardiovascular events, the HRs range from 1.00 (reference) to 2.29 (1.22, 4.31) with a significant trend (P = 0.004). For all-cause mortality, the HRs vary from 1.00 (reference) to 1.59 (1.09, 2.32), also showing a significant trend (P = 0.003). The restricted cubic splines revealed a J-shaped association between the baseline TyG index with cardiovascular events and all-cause mortality in MetS patients. Conclusions The high TyG index was identified as an independent predictor of elevated rates of cardiovascular events among young and middle-aged patients with MetS. Additionally, a J-shaped curve pattern was observed in the association between these factors.

Prevalence and treatment of chronic musculoskeletal pain focused on service gaps: a comparative analysis by age group and body part.

Occupational health, grounded in occupational medicine, aims to enhance the well-being and labor productivity of the working population. Within this realm, there has been growing concern over the increasing instances of labor loss due to diminished physical capacity and the rise in musculoskeletal disorders. Chronic pain is also associated with musculoskeletal disorders. Another pressing issue related to chronic musculoskeletal pain was needed assistance services are underutilized, is referred to as a "service gap". Understanding trends based on age and affected regions of the body is indispensable for developing strategies to address chronic musculoskeletal pain in workers. This study aimed to elucidate age-specific trends in the prevalence and number of pain sites in chronic musculoskeletal pain as well as the patterns of treatment during chronic musculoskeletal pain, categorized by age and affected site. This study was conducted in December 2022 in contract to Cross Marketing Inc. The survey began on December 12, 2022 and ended on December 15, 2022. An online survey was administered to 1,946 participants (973 women and 973 men), and responses were collected, ensuring a roughly equal distribution of samples among men and women across six age groups ranging from their 20 to 70 s. The survey inquired about the presence of chronic pain in each of the eight body parts and the adoption of five different treatments when experiencing pain. Statistical analysis was performed using the chi-square test, with the measurement data categorized by age group and body part. The results indicated a significantly higher prevalence of chronic pain at three or more sites among individuals in their 30 s: the prevalence of pain at each of the eight body sites varied with age. Approximately half of the participants did not engage in specific treatments during episodes of chronic pain. The presence or absence of treatment showed no significant differences according to affected site or age group. This study revealed age- and body part-related relationships with chronic musculoskeletal pain in middle-aged patients and highlighted healthcare service gaps in its management in Japan.

Association of the lipoprotein(a) gene (LPA) p.Ile4399Met variant with lipoprotein(a) level and cardiovascular events in patients following coronary artery bypass grafting under 65 years of age

Abstract Introduction Lipoprotein(a) (Lp[a]), a well-known risk factor for atherosclerotic cardiovascular disease, is largely determined by variation in the Lp(a) gene (LPA) locus encoding apolipoprotein(a). The LPA gene Ile4399Met (rs3798220) variant has been previously reported to have a strong association with the Lp(a) level in patients with coronary artery disease (CAD), however, its prevalence in the middle-age patients after coronary artery bypass grafting (CABG) has not been investigated. Purpose To assess the frequency of the LPA gene c.5673A&amp;gt;G variant (p.Ile4399Met; rs3798220) in Polish patients with CAD following CABG under 65 years of age and determined its association with laboratory and clinical variables. Materials and Methods We studied 215 patients with stable CAD, aged 59.5±4.9 years, who underwent primary and isolated CABG surgery (at age of 57.8±5.4 years), including 195 (90.8%) male. Clinical characteristics and analysis of the LPA c.5673A&amp;gt;G variant were performed. Results The genotype distribution was as follows: AA – 192 (89.3%), AG – 19 (8.8%), and GG – 4 (1.9%). The c.5673G allele carriers had higher Lp(a) level (106.5 [IQR 77.9-149.7] vs 10.4 [IQR 4.4-43.0] mg/dL, p&amp;lt;0.001) compared with non-carriers. Among the c.5673G allele carriers, Lp(a) correlated positively with pack-years of smoking (r=0.563, p=0.045) and fibrinogen (r=0.431, p=0.040), but not with low-density lipoprotein cholesterol (r=0.202, 0.368). There were no other genotype-associated differences with regard to demographic and clinical variable between carriers and non-carriers, including myocardial infarction (56.5% vs 47.9%, p=0.511), peripheral artery disease (21.7% vs 15.1%, p=0.377) and cerebrovascular events (13.0% vs 6.7%, p=0.389). Conclusions To our knowledge, this is the first report on the prevalence of LPA rs3798220 variant in patients with advanced CAD following CABG surgery under 65 years of age. We showed a relatively high (10.7%) percentage of c.5673G allele carriers who have ten times higher Lp(a) levels compared to the wild type, however, its impact on cardiovascular events requires further studies.

Assessment of poor cardiovascular health metrics and related disparities among cancer patients in the United States: a nationwide analysis of over 1.5 million individuals

Abstract Background Cancer, a major health challenge and a leading cause of mortality in the United States, significantly impacts cardiovascular health (CVH). The American Heart Association (AHA) emphasizes several CVH metrics to improve health outcomes, yet disparities in CVH persist nationwide. The specific impact of these disparities on the CVH of individuals with cancer, however, has yet to be fully explored. Purpose This study aims to utilize a detailed and nationally representative dataset from the U.S. to assess the prevalence of poor CVH among adults with a cancer diagnosis, focusing on uncovering sociodemographic disparities. Methods We utilized self-reported data from the Behavioral Risk Factor Surveillance System (2011 to 2019). This system, a state-based telephone survey, gathering data on cancer diagnoses, CVH metrics, and sociodemographic characteristics. We measured CVH through a composite score (0-7) based on the AHA’s seven CVH indicators: hypertension, high cholesterol, smoking, body mass index, diabetes, physical activity, and fruits and vegetables consumption. Individuals scoring between 0 and 2 were defined as having poor CVH. Multivariable generalized linear models within a binomial framework was applied to estimate adjusted prevalence ratios (aPRs) for poor CVH among cancer patients. Results Of 1,575,187 U.S. adults (representing an estimated 154.5 million; 50.7% female, 10.9% non-Hispanic black), 7.8% reported a cancer diagnosis between 2011 and 2019. Adjusted* findings show that having cancer (vs without) associated with a 16% higher prevalence of poor CVH (aPR=1.16; 95% CI [1.12-1.19]). Age-specific analysis revealed increased prevalence of poor CVH in middle-aged (45-64; aPR=3.55) and elderly (≥65; aPR=3.58) cancer patients, indicating a 255% and 358% rise, respectively, with p_interaction &amp;lt;0.001. Female cancer patients experienced a 22% lower prevalence of poor CVH than males (aPR=0.78; p_interaction &amp;lt;0.001). Non-Hispanic black cancer patients faced a 42% higher prevalence of poor CVH than their non-Hispanic white counterparts (aPR=1.42; p_interaction=0.001). Higher-income and education levels associated with 52% and 53% reduced prevalence of poor CVH, respectively (p_interaction &amp;lt;0.001; Table). Conclusions Our research identifies a strong correlation between cancer and deteriorating CVH metrics across U.S. adults, with pronounced variations based on sociodemographic factors. Specifically, the prevalence of poor CVH is substantially higher among cancer patients who are middle-aged, elderly, or identify as non-Hispanic Black, compared to other groups. Conversely, female cancer patients and those with a higher socioeconomic status appear to have a reduced risk of poor CVH. These outcomes stress the critical need for targeted, equitable public health initiatives that address both the cardiovascular and broader health needs of cancer patients, particularly among those most vulnerable.Table1

Prediction of subsequent CKD according to eGFR decline slope varies by the presence of hypertension

Abstract Background We reported that a declining slope in eGFR evaluated from 3-year observation could predict subsequent CKD among the relatively healthy population, even adjusted for baseline eGFR. However, its certainty may vary depending on the presence of comorbidities such as diabetes and hypertension, which are also recognized as the risk factors of CKD. Methods Annual health check-up data from a Japanese company spanning from 2009 to 2022 was used. The analyses included participants having 4 times continuous eGFR measurements for 3 years, undergoing health checkups at least once during a follow-up period, with negative for urinary protein (UP), and non-diabetic. Individual ‘eGFR slopes’ were calculated by the regression line with 4 times eGFR measurements. Participants with slopes of &amp;lt; -5 per year were categorized as the “decreased” group and -5 or more were categorized as the “stable” group. The cases of positive UP or less than 45mL/min/1.73m2 in eGFR during a follow-up period were defined as CKD. Cox regression analyses adjusted for sex, age, and eGFR at baseline were performed to calculate the hazard ratios and 95% CIs for CKD in the decreased group (reference; stable), stratified by hypertension. Results Out of 5598 study participants(men 36%, mean age 48.2±10.1years, mean follow-up period 4.3 years), 260 CKD cases (4.6%) were observed. CKD cases accounted for 4.5% (235/5218) in the stable group and 6.6% (25/380) in the decreased group. Multivariate-adjusted hazard ratios [95%CIs] of CKD by eGFR decline was 1.50[0.99-2.27]. The eGFR decline increased the risk of CKD only in participants with hypertension (2.09[1.09-4.04]), but not in those without hypertension (1.25[0.73-2.13]). After excluding individuals with eGFR slopes exceeding 10 per year to consider for hyperfiltration of eGFR, the results were consistent. Conclusions The eGFR decline over a 3-year observation may predict subsequent CKD only in individuals with hypertension. Key messages • With a relatively short-term evaluation period of three years, eGFR decline can predict subsequent CKD only in hypertensive individuals. • In middle-aged hypertensive patients, it would be important for the prevention of CKD to pay attention not only to low eGFR but also to the progression of eGFR decline.

Soft-tissue keratocyst: report of 3 new cases from Brazil.

To describe the clinicopathological features of 3 new cases of soft-tissue keratocyst (STK) of the buccal mucosa from Brazil. Clinical data from 3 patients diagnosed with STK were obtained from the archives of the Laboratory of Oral Pathology at the Federal University of Rio de Janeiro- Brazil from 2020 to 2023. Two oral pathologists reviewed conventional hematoxylin and eosin-stained slides of each case. Immunohistochemical stainings for CK19, Bcl-2, CD138, D2-40, EMA, and Ki-67 were performed in all cases. Case 1 was a 58-year-old man with a 2-year history of painless swelling of the right buccal mucosa, measuring approximately 5cm. Case 2 was of a 44-year-old man with a painful swelling in the left buccal mucosa lasting 3 years with drainage to the oral cavity. Case 3 was of a 74-year-old woman with a painful swelling in the left buccal mucosa of unknown duration. Microscopic evaluation of all 3 cases revealed a cyst lined with a few cell layers composed of columnar palisading basal cells and a corrugated parakeratin surface. The capsule comprised fibrous connective tissue with variable amounts of blood vessels with hemorrhage, nerve bundles, fat tissue, striated muscle fibers, and the absence of pilosebaceous units. No recurrence was observed after complete surgical removal. All epithelial layers of the 3 cases expressed positivity for CK19 and CD138, the basal cells were positive for Bcl-2 and D2-40, and the superficial epithelial layer was positive for EMA. All cases demonstrated a low proliferation index by Ki-67. This study represents a series of 3 cases of STK that affected the posterior buccal mucosa of middle-aged patients from Brazil, sharing histopathological and immunohistochemical features with odontogenic keratocyst.