Multicenter Case-control Study Research Articles

Exam quality of ultrasound and dynamic contrast-enhanced abbreviated MRI and impact on early-stage HCC detection.

MRI is a potential alternative to ultrasound for hepatocellular carcinoma (HCC) detection. We evaluated the impact of ultrasound and dynamic abbreviated MRI (AMRI) exam quality on early-stage HCC detection. We conducted a multicenter case-control study among patients with cirrhosis (cases with early-stage HCC per Milan Criteria; controls without HCC) who underwent both a liver ultrasound and dynamic contrast-enhanced (DCE) AMRI within 6 months in 2012-2019. Two radiologists performed independent, blinded interpretations of both exams for HCC detection and scored exam quality as no/mild, moderate, or severe limitations. Associations between exam quality, patient characteristics, and HCC detection were assessed by odds ratios (OR). Of 216 cases and 432 controls, severe limitations were reported in 7% and 8% of ultrasounds and DCE-AMRIs, respectively. Severe limitations at ultrasound were associated with obesity (OR 2.08, 95%CI [1.32-3.32]) and metabolic dysfunction-associated steatotic liver disease (MASLD) (OR 1.98 [1.12-3.44]) but not for DCE-AMRI. Decompensated cirrhosis (Child-Pugh C) was associated with severe limitations for both ultrasound (OR 2.54 [1.37-4.58]) and DCE-AMRI (OR 3.96 [2.36-6.58]). Compared to exams with no/mild limitations, exams with severe limitations had lower sensitivity for ultrasound (79.6% vs. 21.7%, P < 0.001) and AMRI (86.1% vs. 50.0%, P = 0.001). In patients in whom ultrasound was severely limited, DCE-AMRI had significantly higher odds of early-stage HCC detection than ultrasound (OR 8.23 [1.25-54.02]). HCC detection by DCE-AMRI may be preferred in patients with severe limitations at ultrasound due to obesity and MASLD. Both modalities remain limited for patients with decompensated cirrhosis, for whom alternative strategies may be needed.

Abstract 4121733: Comprehensive Plasma Proteomics Profiling Identifies Circulating Biomarkers to Distinguish Hypertrophic Cardiomyopathy from Other Cardiomyopathies with Left Ventricular Hypertrophy

Introduction: Hypertrophic cardiomyopathy (HCM) is the most common genetic cardiomyopathy. It is sometimes challenging to distinguish HCM from other cardiomyopathies that cause left ventricular hypertrophy (LVH) such as hypertensive LVH, transthyretin cardiac amyloidosis (ATTR-CA), and aortic stenosis (AS). We aimed to identify a set of plasma protein biomarkers that distinguishes HCM from the other cardiomyopathies with LVH. Methods: In this multi-center case-control study, we conducted plasma proteomics profiling of 4,979 proteins in cases with HCM (n=879) and controls with hypertensive LVH (n=331), ATTR-CA (n=169), and AS (n=36). We identified clinical parameters that were significantly (univariable P&lt;0.05) different between HCM and hypertensive LVH. We then specified proteins that were significantly (multivariable P&lt;0.001) upregulated or downregulated in HCM compared to hypertensive LVH by performing multivariable logistic regression analysis on each protein adjusting for the identified clinical parameters (comparison #1). We performed the same analysis between HCM and ATTR-CA (comparison #2) as well as between HCM and AS (comparison #3). We identified proteins that were upregulated in HCM in all 3 comparisons. We also specified proteins downregulated in HCM throughout all 3 comparisons. Finally, using these proteins, we constructed a logistic regression model to distinguish HCM from all 3 control groups combined, and calculated an area under the receiver-operating-characteristics curve (AUROC). Results: Eight clinical parameters listed in Image 1 were significantly different between HCM and the controls and adjusted for in the multivariable logistic regression analyses. In the comparison between HCM and hypertensive LVH, 444 proteins were upregulated and 267 downregulated with multivariable P&lt;0.001 ( Image 1 ). There were 226 upregulated and 170 downregulated proteins comparing HCM with ATTR-CA, and 57 upregulated and 74 downregulated proteins when comparing HCM with AS ( Image 1 ). Among these proteins, 4 were upregulated in all 3 comparisons with multivariable P&lt;0.001 and 5 were downregulated ( Image 2 ). The logistic regression model with these 9 proteins had AUROC of 0.86 (95% confidence interval 0.84-0.88, Image 3 ). Conclusions: This study serves as the first to apply comprehensive proteomics profiling to identify circulating biomarkers that distinguish HCM from other cardiomyopathies with LVH independently from potential confounders.

Comprehensive Proteomics Profiling Identifies Circulating Biomarkers to Distinguish Hypertrophic Cardiomyopathy from Other Cardiomyopathies with Left Ventricular Hypertrophy.

Background: Distinguishing hypertrophic cardiomyopathy (HCM) from other cardiomyopathies with left ventricular hypertrophy (LVH), such as hypertensive LVH, transthyretin amyloid cardiomyopathy (ATTR-CM), and aortic stenosis (AS), is sometimes challenging. Using plasma proteomics profiling, we aimed to identify circulating biomarkers and dysregulated signaling pathways specific to HCM. Methods: In this multicenter case-control study, plasma proteomics profiling was performed in cases with HCM and controls with hypertensive LVH, ATTR-CM, and AS. Two-thirds of patients enrolled earlier in each disease group were defined as the training set, and the remaining one-third as the test set. Protein concentrations in HCM were compared with those in hypertensive LVH (comparison 1), ATTR-CM (comparison 2), and AS (comparison 3). Candidate proteins that meet the following 2 criteria were selected: (1) Higher abundance in HCM throughout all 3 comparisons or lower abundance in HCM throughout all 3 comparisons with univariable P<0.05 and |log2(fold change)| >0.5 in both the training and test sets and (2) Independently associated with HCM with multivariable P<0.05 after adjusting for clinical parameters significantly different between HCM and controls. Using the selected candidate proteins, a logistic regression model to distinguish HCM from controls was developed in the training set and applied to the test set. Finally, pathway analysis was performed in each comparison using proteins with different abundance. Results: Overall, 4,979 proteins in 1,415 patients (HCM, n=879; hypertensive LVH, n=331; ATTR-CM, n=169; AS, n=36) were analyzed. Of those, 5 proteins were selected as candidate proteins. The logistic regression model with these 5 proteins had an area under the receiver-operating-characteristic curve of 0.86 (95% CI 0.82-0.89) in the test set. The MAPK and HIF-1 pathways were dysregulated in HCM throughout the 3 comparisons. Conclusions: This study identified circulating biomarkers that distinguish HCM from other cardiomyopathies with LVH independently from confounders and revealed signaling pathways associated with HCM.

Exploring the Association between Prior Cancer History and Risk of Head and Neck Cancer: Insights from a Multi-Centre Retrospective Case-Control Study.

Exploring the Association between Prior Cancer History and Risk of Head and Neck Cancer: Insights from a Multi-Centre Retrospective Case-Control Study.

Closure of gastric mucosal defects using the reopenable-clip over the line method to decrease the risk of bleeding after endoscopic submucosal dissection: a multicenter propensity score-matched case-control study (with video)

Background and AimsEndoscopic submucosal dissection (ESD) is a minimally invasive treatment for early gastric cancer. However, post-ESD bleeding presents significant risks. Closing mucosal defects following ESD may reduce the incidence of post-ESD bleeding. Currently, no optimal closure method exists. Therefore, we invented clip-line closure using the reopenable-clip over the line method (ROLM) and evaluated its efficacy in preventing post-ESD bleeding. MethodsWe retrospectively reviewed data from patients who underwent gastric ESD between January 2012–March 2024. Patients were categorized into two groups: the non-closure group (mucosal defect remained unclosed) and the ROLM group (defect was closed using ROLM). Baseline characteristics of patients, distribution of bleeding risk factors, and incidence and timing of post-ESD bleeding were compared between the groups. Propensity score matching was employed to minimize potential bias. ResultsFollowing propensity score-matching, 162 ESDs were performed for 168 lesions in the non-closure group, whereas 160 ESDs were performed for 168 lesions in the ROLM group. The mean long diameter of the mucosal defects, procedure time for ROLM, and number of clips required for ROLM were 45.9 mm, 35.6 min, and 33.2, respectively. All mucosal defects resulting from the ESD were fully closed using ROLM. The post-ESD bleeding rate in the ROLM group was significantly lower (1.8%, 3/168 lesions) than in the non-closure group (7.7%, 13/168 lesions, p = 0.02). ConclusionsROLM is feasible for mucosal defect closure following gastric ESD and effectively prevents post-ESD bleeding in high-risk patients, addressing a significant gap in existing methods.

In-Hospital Mortality Among Elderly Patients Hospitalized for Femur Fracture with and Without Diabetes Mellitus: A Multicenter Case-Control Study.

Purpose: The aim of the present study was to explore whether diabetes mellitus (DM) is associated with in-hospital mortality in patients admitted for femur fractures. Methods: Our multicenter case-control study included patients aged ≥65 with a primary diagnosis of femur fracture with and without DM treated in 36 German hospitals between January 2019 and December 2023. Patients with DM were matched to patients without DM (1:3) using propensity scores based on age and sex. Multivariable logistic regression analyses were conducted to assess the associations between DM and in-hospital mortality. Results: A total of 3220 patients with diabetes and 9660 patients without diabetes were included (mean age: 83 years). The overall in-hospital mortality rate was higher in DM patients (6.4%) than in those without DM (5.4%). However, the association between DM and in-hospital mortality was not significant after adjustment for other co-diagnoses. In particular, atrial fibrillation, heart failure, and CKD attenuated the effect of DM on in-hospital mortality. Conclusions: Our data show that DM is not significantly associated with in-hospital mortality in femur fracture patients. However, the presence of other comorbidities may influence mortality outcomes, highlighting the need for early intervention and targeted treatment to improve patient outcomes.

The Impact of acne on the mental health of women and young adults, a case-control multicenter study of 300 patients in Lomé, Togo, West Africa

Background: This study explores the relationship between acne and anxiety, both common health issues among young adults. Acne, a chronic inflammatory skin condition, can significantly impact an individual's self-esteem and quality of life. Anxiety, characterized by feelings of imminent danger and distress, often exacerbates this impact. While the association between acne and anxiety has been well-studied in developed countries, research in Africa, particularly in Togo, is limited. Materials and Methods: A case-control study was conducted over eight months, from July 2017 to February 2018, in three public dermatology clinics in Lomé, Togo. The study included 300 acne patients, matched with 600 controls based on age (±5 years) and gender. Data were collected through structured interviews, clinical examinations, and validated questionnaires like the General Anxiety Disorder-7 (GAD-7) for anxiety assessment. Results: Out of 4,126 dermatology patients, 300 (7.3%) consulted for acne, with young adults representing the majority. The study found a significant correlation between acne and anxiety, with a higher prevalence of anxiety among acne patients compared to the control group. Conclusion: The findings highlight the psychological burden and mental health impact of acne in young adults in general and of women, emphasizing the need for a holistic approach to acne treatment that includes mental health support integrated in dermatologic treatment. Further research is recommended to explore this relationship in different African cultural contexts.

No association between the novel international classification of bicuspid aortic valve anatomy and performed surgery of the valve or aorta

Abstract Introduction In 2021, international experts introduced a new classification of the diverse anatomy of bicuspid aortic valves (BAV). This classification identifies three BAV types: Fusion, 2-sinus, and Partial-fusion BAV, which may be further subdivided into specific phenotypes according to orientation of the commissure and the presence of a raphe. However, it remains uncertain whether this new BAV classification can identify subgroups of patients with an unfavorable long-term prognosis. Purpose To assess whether the BAV anatomy according to the new classification is associated with the risk of surgery of the aortic valve or aorta. Methods A multicenter case-control study of all current patients with BAV from the outpatient clinics of three major cardiology departments in Denmark in the years 2018, 2019 and 2022. We excluded patients with more than minor concomitant heart defects, uncertain BAV anatomy, and genetic syndromes. Due to the novelty of the concept at the time of study, we excluded 15 patients with Partial-Fusion BAV. Because echocardiography examinations performed prior to January 1 2006 were unavailable, we excluded patients diagnosed prior to this date to ensure comparability between cases and controls. Cases were all patients with BAV, who had had surgery of the aortic valve and/or surgery of the ascending aorta at the end of their accrual year. All other patients with BAV were controls. We assessed BAV anatomy by review of routinely performed echocardiography examinations and compared patients according to BAV type: Fusion or 2-sinus BAV. Secondarily, we compared patients with specific phenotypes: Right-Left Fusion, Right-Non-Coronary Fusion, Left-Non-Coronary Fusion, Latero-Lateral 2-sinus, and Antero-Posterior 2-sinus BAV. Results We included 931 patients (237 cases, 694 controls). Table 1 displays clinical characteristics in BAV phenotype subgroups. In the primary analysis, we found no significant difference in the odds of surgery between the Fusion versus 2-sinus BAV: unadjusted OR 0.65, 95% CI [0.41-1.03]. This did not change after adjusting for age and sex in a logistic regression model: OR 0.72, 95% CI [0.45-1.15]. Results were similar when comparing phenotypes; no difference in odds of surgery between phenotypes in both unadjusted and age- and sex-adjusted analyses (see Fig. 1). In exploratory analyses, we compared patients according to the orientation of the BAV commissure (latero-lateral versus antero-posterior) and a more complex definition of the fusion phenotype that incorporates the visibility of a raphe. Findings were similar; no significant difference in the odds between subgroups. In all models, increasing age and male sex were associated with higher odds of surgery. Conclusion In this study, we did not find any association between BAV anatomy as defined by the new international consensus classification, and performed surgery of the valve or aorta.

Clinical characteristics and prognosis of bloodstream infections with carbapenem-resistant Gram-negative organisms in patients with hematological malignancies: A multicenter case-control study in China

To investigate clinical characteristics of hematological malignancy (HM) patients with carbapenem-resistant gram-negative organism (CRO) bloodstream infections (BSI) in China, and to elucidate the prognostic risk factors of CRO BSI. We conducted a multicenter case-control study of 201 HM patients with CRO BSI between 2018-2020. Antimicrobial susceptibility testing and whole genome sequencing were performed for CRO isolates. Independent risk factors for 28-day crude mortality of were analyzed using Cox proportional hazards regression models. The subgroups of major species were also evaluated. The pathogens responsible for CRO BSI in HM patients dominated by ST11 CRKP, ST167 CREC and ST463 CRPA. Most isolates produced carbapenemases with KPC and NDM being the main. CRO isolates had resistance rates to conventional antimicrobials ranging from 55%-100% and poor susceptibility to novel antimicrobials related to carbapenemases and species. The 28-day crude mortality was 24.2%. Non-Hodgkin lymphoma, heart disease, blaKPC-2 positive, empirical antibiotic therapy with linezolid, Pitt bacteremia score >3.5 were risk factors for 28-day mortality and appropriate definitive antibiotic therapy, tigecycline-containing therapy and aminoglycoside-containing therapy were protective factors. blaKPC-2 positive in CRKP and ST463 in CRPA were associated with Pitt bacteremia score > 3.5. Solid tumor and other site infections before BSI were risk factors for ST463 CRPA BSI and Pulmonary infection before BSI was risk factor for KPC-KP BSI. The antimicrobial resistance of CRO isolates for BSI in HM patients is critical. HM patients with CRO BSI should be treated with appropriate definitive antibiotic therapy based on early clarification of pathology and their antimicrobial susceptibility.

Determinants of unsuccessful tuberculosis treatment outcome in Southwest Ethiopia regional state public hospitals, 2022: a multi-center case control study.

Tuberculosis is the major cause of morbidity, and it is one of the top ten causes of death globally. In Africa, the overall pooled estimate of unsuccessful tuberculosis treatment outcome was reported to be 21.1%, which is above the World Health Organization defined threshold of 15%. Unsuccessful treatment outcomes result in drug resistance, prolonged periods of infection, and increased morbidity and mortality. Therefore, this study aimed to assess determinants of unsuccessful treatment outcomes among tuberculosis patients in Southwest Ethiopia regional state public hospitals, in 2022. A retrospective unmatched case-control study was employed by recruiting 570 study units (190 cases and 380 controls) in three randomly selected public hospitals from 1 August 2022 to 21 August 2022. Data were collected by using a data extraction checklist adapted from tuberculosis registration logbook. Bivariate and multivariate logistic regression models were employed. A predictor variable with a p-value of less than 0.05 in the multivariate logistic regression model was taken as statistically significant. The odds ratio and 95% confidence level were used to measure the strength of the association. A total of 561 records (187 cases and 374 controls) were included from tuberculosis registers. In this study, the factors independently associated with unsuccessful tuberculosis treatment outcome were older age (AOR = 1.68, 95% CI: 1.142, 2.472), rural residence (AOR = 1.548, 95% CI: 1.055, 2.272), retreatment category (AOR = 2.12, 95% CI: 1.339, 3.357), underweight (BMI < 18.5 kg/m2) (AOR = 1.952, 95% CI: 1.240, 3.071), being HIV positive (AOR = 2.144, 95% CI: 1.372, 3.349) and having no treatment adherence support (AOR = 2.016, 95% CI: 1.270, 3.201). In this study, socio-demographic, clinical, and treatment-related factors contributed to the risk of unsuccessful treatment outcomes. Targeted interventions should be taken into consideration to diminish poor tuberculosis treatment outcomes among high-risk groups throughout the whole tuberculosis treatment course.

Pregnancy-Induced Hypertensive Disorders predictors among pregnant and delivery mothers receiving care in public health institutions in Sidama, Ethiopia: a multicenter case control study

BackgroundPregnancy-Induced Hypertensive Disorders (PIHD) include conditions like Pre-Eclampsia, Eclampsia, and Gestational Hypertension, impacting 5–10% of pregnancies globally. These disorders are responsible for 16% of maternal deaths in Sub-Saharan Africa and account for 16.9% of maternal mortality in Ethiopia, representing 10% of the country's total maternal deaths.ObjectiveTo identify predictors of PIHD among pregnant and delivery women in public hospitals and primary health care units (health centers) in Sidama, Ethiopia.MethodsA multi-center unmatched case–control study was conducted on women in antenatal care and obstetrics/gynecology departments at 12 randomly selected public health institutions, including one specialized teaching hospital, two general hospitals, three primary hospitals, and six health centers. The study involved 920 women (230 cases and 690 controls) selected from December 2023 to February 2024. Cases included pregnant or delivery women at 20 + weeks gestation with PIHD such as pre-eclampsia, eclampsia, gestational hypertension, and chronic hypertension with superimposed preeclampsia. Controls were normotensive pregnant women or delivering mothers without PIHD after 20 weeks gestation. Data was manually verified, entered, and validated using Epidata software, followed by analysis with SPSS 22. Univariate analysis assessed predictors of PIHD, while binary logistic regression evaluated the relationships between factors. Model fitness was checked using collinearity assessments and the Hosmer–Lemeshow test, with variables having a P value < 0.05 deemed independent predictors.ResultsOut of 920 planned participants, 686 were included, resulting in a response rate of 94.35%. Factors associated with PIHD in women included age at first conception (AOR = 1.26), mid (AOR = 6.05) and high (AOR = 5.01) wealth index levels, multigravidity (AOR = 4.34), pregnancy age ≥ 42 weeks (AOR = 3.65), maternal mid-upper arm circumference (MUAC) (AOR = 1.29), hemoglobin levels of 6.5–10.9 g/dL (AOR = 5.59), pre-pregnancy Body Mass Index (BMI) ≥ 25 kg/M2 (AOR = 0.81), preexisting hypertension (AOR = 8.97), family history of diabetes mellitus (AOR = 20.02), former alcohol consumption (AOR = 0.27), and total physical activity during pregnancy (AOR = 0.54).ConclusionsThe study identifies key predictors of PIHD in women, including age at conception, wealth index, multigravidity, gestational age, and pre-pregnancy BMI. It underscores the link between socioeconomic status and maternal health, highlighting that financial resources alone don’t ensure better outcomes without educational access. The research advocates for a health intervention strategy focusing on socioeconomic factors and public health initiatives to reduce maternal health disparities while exploring the role of partner stability and psychosocial aspects.

Partnership and relationship happiness in endometriosis related chronic pelvic pain: a multicenter case-control study.

Partnership is an important resource in dealing with endometriosis related chronic pain. Hence, our objective was to assess partnership in the context of endometriosis and its symptoms, considering the perspectives of both individuals involved. The study was designed as a multi-center matched case-control study in Switzerland, Germany and Austria. Altogether 381 women with surgically/histologically confirmed endometriosis and 381 control women, 250 male partners of endometriosis-affected women and 229 of control women were evaluated. Partnership quality, partnership happiness, separation thoughts, and areas of conflict were evaluated through the Partnership Questionnaire and a validated list of conflict areas. Quality of partnership was rated as high by 60.1% of the women with endometriosis and 66.7% of the control women, as well as by 45.8 and 50.2% of their respective partners. Women with endometriosis mentioned separation thoughts, mostly related to sexual satisfaction, more often (34.9%/28.3%) and experienced more partnership-related conflicts than control women. Chronic pain, dyspareunia, dissatisfaction with sexuality, fatigue, and infertility were significantly associated with partnership conflicts. Fatigue and infertility but not pain experiences were related to lower partnership quality. Male partners in both groups reported separation thoughts equally often. In men, a high intensity of pain experienced by their partner was associated with reduced partnership happiness. Given the significance of partnership in dealing with chronic diseases and the connection between symptoms of endometriosis and a decrease in partnership quality, it is essential to incorporate strategies that alleviate the negative impacts on relationships for both partners into medical support. identifier NCT02511626.

Determinants of meconium-stained amniotic fluid among women delivered at southwestern referral hospitals, Southwest Ethiopia: a multi-center case-control study

BackgroundMeconium-stained amniotic fluid (MSAF) is a condition in which meconium is present in the uterus during ante-natal and complicates 10–15% of all live births. Scanty information is known about the determinants of meconium-stained amniotic fluid. Hence, this study aimed to identify determinants of meconium-stained amniotic fluid among women delivered at southwestern referral hospitals in southwest Ethiopia, in 2024.MethodsAn institutional-based case-control study was employed from January 1, 2024, to June 30, 2024. The study was conducted in four southwestern referral hospitals in southwest Ethiopia. The final sample size includes 321(107 cases and 214 controls). The sample size was proportionally allocated for cases and controls for each referral hospital. Simple random sampling was used to select patient charts and data was collected from the chart using questions/tools developed after reviewing relevant literature. Data were entered using Epi-data version 3.1 and analyzed using SPSS version 25. Data was analyzed using binary logistic regression. All independent variables with P- the value of < 0.25 in univariable analysis were considered for multivariable logistic regression. Determinant factors of meconium-stained amniotic fluid were identified at a 95% confidence interval with a p-value < 0.05 was utilized to declare statistical significance.ResultsA total of 107 cases and 214 controls were included in this study. The finding from this study stated that induction of labor [AOR = 2.37, 95% CI = 1.28–8.89], obstructed labor [AOR = 2.62, 95%CI = 1.1–6.79], duration of labor greater than 24 h [AOR = 2.8, 95% CI = 1.55–15.44], and premature rupture of the membrane [AOR = 2.98, 95%CI = 1.1–8.23] were found to be significantly associated with meconium-stained amniotic fluid.ConclusionConclusively, a mother with induced or obstructed labor, labor duration greater than 24 h, and premature rupture of membrane need special attention during delivery care to reduce potential risk factors to feto-maternal outcomes related to meconium-stained amniotic fluid.

Prognostic Value of Coronary Artery Calcification in Patients with COVID-19 and Interstitial Pneumonia: A Case-Control Study.

Background: Patients suffering from coronavirus disease-19 (COVID-19)-related interstitial pneumonia have variable outcomes, and the risk factors for a more severe course have yet to be comprehensively identified. Cohort studies have suggested that coronary artery calcium (CAC), as estimated at chest computed tomography (CT) scan, correlated with patient outcomes. However, given that the prevalence of CAC is gender- and age-dependent, the influence of baseline confounders cannot be completely excluded. Methods: We designed a retrospective, multicenter case-control study including patients with COVID-19, with severe course cases selected based on death within 30 days or requiring invasive ventilation, whereas controls were age- and sex-matched patients surviving up to 30 days without invasive ventilation. The primary outcome was the analysis of moderate-to-severe CAC prevalence between cases and controls. Results: A total of 65 cases and 130 controls were included in the study. Cases had a significantly higher median pulmonary severity score at chest CT scan compared to controls (10 vs. 8, respectively; p = 0.0001), as well as a higher CAC score (5 vs. 2; p = 0.009). The prevalence of moderate-to-severe CAC in cases was significantly greater (41.5% vs. 23.8%; p = 0.013), a difference mainly driven by a higher prevalence in those who died within 30 days (p = 0.000), rather than those requiring invasive ventilation (p = 0.847). White blood cell count, moderate-to-severe CAC, the need for antibiotic therapy, and severe pneumonia at CT scan were independent primary endpoint predictors. Conclusions: This case-control study demonstrated that the CAC burden was higher in COVID-19 patients who did not survive 30 days or who required mechanical ventilation, and CAC played an independent prognostic role.

The Neuroconnective Endophenotype, A New Approach Toward Typing Functional Neurological Disorder: A Case-Control Study.

Functional neurological disorder (FND) is a core neuropsychiatric condition that includes both physical and mental symptoms. Recently, a validated clinical phenotype termed neuroconnective endophenotype (NEP), which includes several physical and psychological characteristics together with joint hypermobility (hypermobility spectrum disorders), was found at a significantly higher frequency among patients with anxiety. The purpose of the present study was to examine the presence of the NEP among patients with FND. The authors conducted a multicenter case-control study comprising 27 FND patients and 27 healthy control participants (matched by sex and age) ages 13 to 58 years. Eight questionnaires were administered. Proportional differences were examined with Student's t tests, one-way analyses of variance, and chi-square tests. Differences between FND patients and control participants were observed. FND patients had higher sensory sensitivity, increased prevalence of hypermobility features (including relevant physical signs and symptoms), greater frequency of polarized behaviors, a greater number of both psychiatric and physical comorbidities, and an increase in the characteristics and sensations typical of anxiety. Particularly striking was the presence of the hypermobility spectrum in more than 75% of FND patients compared with 15% among control participants. FND patients presented higher scores in all five dimensions included in the NEP. Thus, this phenotype, solidifying the original association between anxiety and the hypermobility spectrum, could help to identify an FND subtype when evaluating and managing FND patients, because it provides a new global view of patients' physical and mental symptoms.

Patients with Neurological or Psychiatric Complications of COVID-19 Have Worse Long-term Functional Outcomes: COVID-CNS- A Multicentre Case-control Study

Patients with Neurological or Psychiatric Complications of COVID-19 Have Worse Long-term Functional Outcomes: COVID-CNS- A Multicentre Case-control Study

Relationship between maternal anemia during pregnancy and the risk of preeclampsia: A multicenter case-control study.

Introduction: Anemia, defined as a low hemoglobin level, is a common condition in pregnancy that can have adverse effects on maternal and fetal outcomes. Anemia can result from various causes, such as iron deficiency, vitamin B12 deficiency, folate deficiency, hemolysis, or bleeding. The association between anemia and preeclampsia is not fully understood, but some studies have suggested that anemia may increase the risk of developing preeclampsia, especially in women with iron deficiency or chronic inflammation. Objective: To assess the association of anemia during pregnancy and the risk of developing preeclampsia. Study Design and Setting: A multicenter unmatched case-control study was conducted. The study was conducted from 2 December 2020 to 1 January 2021 in West and North Gojjam zone governmental hospitals, North West Ethiopia. A total of 337 pregnant women (113 cases and 224 controls) who consented verbally and attended antenatal or delivery services were enrolled in the study. Population: The participants of this study were mothers attending attended antenatal care and delivery services. Data Management: The analysis involved manual checking, data entry using EpiData Manager, and subsequent analysis using SPSS version 23, with logistic regression and p-values <0.05 determining statistical significance. Results: Being nonanemic, high consumption of fat related, mid-upper arm circumference ≥25.6 cm, frequent consumption of milk products, and fruits and vegetables rich in vitamin A were found to be factors associated with the risk for developing preeclampsia. Conclusion and recommendations: Being nonanemic, diets that are characterized by a high intake of vitamin A-rich fruits and vegetables and milk products were significantly associated with a low risk of preeclampsia. On the other hand, high intake of fatty foods and obesity were associated with the development of preeclampsia. Therefore, preventing anemia encouraging and promoting healthy eating habits during pregnancy by including vitamin A-rich fruits and vegetables and milk products can effectively prevent the development of preeclampsia.

Lung Structure and Longitudinal Change in Cardiac Structure and Function: The MESA COPD Study.

Lung structure and cardiac structure and function are associated cross-sectionally. The classic literature suggests relationships of airways disease to cor pulmonale and emphysema to reduced cardiac output (CO) but longitudinal data are lacking. The Multi-Ethnic Study of Atherosclerosis Chronic Obstructive Pulmonary Disease (COPD) Study was a multi-center longitudinal COPD case-control study of participants 50-79 years with ≥10 pack-years smoking without clinical cardiovascular disease. Segmental airway wall area (WA) and percent emphysema were measured on computed tomography. Right and left ventricle (RV, LV) parameters were assessed on magnetic resonance imaging (MRI) in exams six years apart. Longitudinal and period cross-sectional associations were evaluated with mixed models adjusted for demographics, body size, and smoking. The 187 participants with repeated MRI were 67±7 years old; 42% had COPD; 22% currently smoked; and the race/ethnicity distribution was 54% white, 30% Black, 14% Hispanic, and 3% Asian. Greater WA at enrollment was associated with longitudinal increase in RV mass (3.5 g per 10mm2 WA, 95% CI: 1.1, 5.9). Greater percent emphysema was associated with stably lower LV end diastolic volume (-7.8 mL per 5% emphysema, 95% CI: -10.3, -3.0) and CO (-0.2 L·min-1 per 5% emphysema, 95% CI: -0.4, -0.1). Cardiac associations varied by lung structure over six years in this multi-ethnic study. Greater WA at enrollment was associated with longitudinal increases in RV mass; whereas greater percent emphysema was associated with stable decrements in LV filling and CO.

Comprehensive Proteomic Profiling of Human Myocardium Reveals Signaling Pathways Dysregulated in Hypertrophic Cardiomyopathy

BackgroundHypertrophic cardiomyopathy (HCM) is the most common genetic cardiac disease. Signaling pathways that link genetic sequence variants to clinically overt HCM and progression to severe forms of HCM remain unknown. ObjectivesThe purpose of this study was to identify signaling pathways that are differentially regulated in HCM, using proteomic profiling of human myocardium, confirmed with transcriptomic profiling. MethodsIn this multicenter case-control study, myocardial samples were obtained from cases with HCM and control subjects with nonfailing hearts. Proteomic profiling of 7,289 proteins from myocardial samples was performed using the SomaScan assay (SomaLogic). Pathway analysis of differentially expressed proteins was performed, using a false discovery rate <0.05. Pathway analysis of proteins whose concentrations correlated with clinical indicators of severe HCM (eg, reduced left ventricular ejection fraction, atrial fibrillation, and ventricular tachyarrhythmias) was also executed. Confirmatory analysis of differentially expressed genes was performed using myocardial transcriptomic profiling. ResultsThe study included 99 HCM cases and 15 control subjects. Pathway analysis of differentially expressed proteins revealed dysregulation of the Ras–mitogen-activated protein kinase, ubiquitin-mediated proteolysis, angiogenesis-related (eg, hypoxia-inducible factor-1, vascular endothelial growth factor), and Hippo pathways. Pathways known to be dysregulated in HCM, including metabolic, inflammatory, and extracellular matrix pathways, were also dysregulated. Pathway analysis of proteins associated with clinical indicators of severe HCM and of differentially expressed genes supported these findings. ConclusionsThe present study represents the most comprehensive (>7,000 proteins) and largest-scale (n = 99 HCM cases) proteomic profiling of human HCM myocardium to date. Proteomic profiling and confirmatory transcriptomic profiling elucidate dysregulation of both newly recognized (eg, Ras–mitogen-activated protein kinase) and known pathways associated with pathogenesis and progression to severe forms of HCM.

Association of Soy Foods With Gastric Cancer Considering Helicobacter pylori: A Multi-Center Case-Control Study.

This study aims to explore the relationship between soy food consumption and gastric cancer (GC) risk, accounting for Helicobacter pylori infection status. We analyzed data from patients with GC and healthy individuals prospectively enrolled by 6 hospitals between 2016 and 2018. Dietary intake was evaluated using questionnaires that categorized seven dietary habits and 19 food groups. Multivariate logistic regression models were applied to examine associations. Model I adjusted for various epidemiological factors, while Model II included further adjustments for H. pylori infection. Primary exposures examined were consumption frequencies of nonfermented, unsalted soy foods (soybean/tofu) and fermented, salty soy foods (soybean paste stew). A total of 5,535 participants were included, with 1,629 diagnosed with GC. In Model I, the frequency of soybean/tofu consumption was inversely related to GC risk; adjusted odd ratios (aORs) were 0.62 (95% confidence interval [CI], 0.48-0.8), 0.38 (95% CI, 0.3-0.49), 0.42 (95% CI, 0.33-0.53), and 0.33 (95% CI, 0.27-0.42) for 1 time/week, 2 times/week, 3 times/week, and ≥4 times/week. Consumption of 2 servings/week of soybean paste stew showed the lowest GC association, forming a V-shaped curve. Both low (aOR, 4.03; 95% CI, 3.09-5.26) and high serving frequencies of soybean paste stew (aOR, 2.23; 95% CI, 1.76-2.82) were associated with GC. The association between soy foods and GC in Model II was similar to that in Model I. The soy food-GC associations were consistent across sexes in Model I. Nonetheless, the positive correlation between frequent consumption of soybean paste stew (≥5 times/week) and GC was more pronounced in women (aOR, 7.58; 95% CI, 3.20-17.99) compared to men (aOR, 3.03; 95% CI, 1.61-5.88) in Model II. Subgroup analyses by H. pylori status and salty diet revealed a consistent inverse relationship between soybean/tofu and GC risk. In contrast, soybean paste stew showed a V-shaped relationship in H. pylori-positive or salty diet groups and no significant association in the H. pylori-negative group. Soybean/tofu intake is consistently associated with a decreased risk of GC. However, the relationship between soybean paste stew consumption and GC risk varies, depending on H. pylori infection status and dietary salt intake. ClinicalTrials.gov Identifier: NCT03046745.