Non-elevated Group Research Articles

A retrospective study on the relationship between plasma β-hydroxybutyric acid levels and short-term prognosis of cardiac function in patients with acute myocardial infarction combined with heart failure

Abstract Background Ketone body metabolism can improve cardiomyocytes metabolism and reduce myocardial oxygen consumption; however, its role in the short-term prognosis of patients with acute myocardial infarction combined with heart failure has not been clearly elucidated. The aim of this study was to investigate the effect of β-hydroxybutyric acid, the main component of ketone bodies, on the short-term prognosis of patients with acute myocardial infarction combined with heart failure. Methods This was a retrospective observational study that enrolled patients admitted to the Qilu Hospital of Shandong University for acute myocardial infarction combined with heart failure between January 1, 2019, and December 31, 2022. According to whether β-hydroxybutyric acid was elevated or not, subjects were divided into a β-hydroxybutyric acid elevated and nonelevated groups, to observe the difference in cardiac function improvement between the two groups. Results This study included a total of 260 patients, of which 170 exhibited elevated levels of β-hydroxybutyric acid. Compared to the patients in the nonelevated group, patients in the elevated β-hydroxybutyric acid group had higher plasma levels of creatine kinase myocardial band and greater Gensini scores. Multivariate logistic regression analysis indicated that an increase in β-hydroxybutyric acid levels (odds ratio: 2.517; 95% confidence intervals: 1.394–4.597; P = 0.002) is an independent protective factor affecting the prognosis of cardiac function in patients with acute myocardial infarction combined with heart failure. Conclusion In patients with acute myocardial infarction combined with heart failure, plasma β-hydroxybutyric acid serves as an independent protective factor for short-term improvement in cardiac function.

Effect of Blood Glucose Gap on Post-stroke Cognitive Impairment in Acute Ischemic Stroke Patients

Objective: To analyze the effect of the blood glucose gap on post-stroke cognitive impairment in acute ischemic stroke patients. Methods: 300 stroke patients admitted to the hospital between December 2021 and December 2022 were selected and divided into three groups according to the value of blood glucose gap: the group with no elevation of blood glucose gap (n = 124), the group with mild elevation of blood glucose gap (n = 97), and the group with elevated blood glucose gap (n = 79). The same treatment regimen was applied to these three groups and cognitive function was assessed using MMSE and MoCA at 3, 6, and 12 months after discharge. Results: The NIHSS and MoCA scores of the patients in the group with elevated blood glucose gap were significantly higher than those in the mildly elevated group and the non-elevated group at 3, 6, and 12 months after discharge, and the MMSE and MoCA scores of the patients in the group with mildly elevated blood glucose gap were significantly higher than those in the non-elevated group at 3, 6, and 12 months after discharge, and there were statistically significant differences between all the groups (P < 0.05). Conclusion: Patients with an elevated glycemic gap in acute ischemic stroke showed more pronounced cognitive impairment than those with no elevated glycemic deficit, and the severity of cognitive impairment increased with the degree of glycemic deficit.

Correlation between lipoprotein(a) and recurrent ischemic events post-cerebral vascular stent implantation

Background and aimThe association of Lipoprotein(a) (Lp[a]) with recurrent ischemic events in stented patients remains uncertain. So, this research aimed to investigate the impact of elevated Lp(a) levels on the occurrence of ischemic events in this specific patient population. MethodsTotally 553 patients who underwent intracranial or extracranial artery stent implantation were included. Baseline data were collected and postoperative ischemic outcomes were followed up. Cox regression analysis was used to investigate the association between Lp(a) and outcomes, while accounting for confounding factors. Finally, we established prediction models based on nomogram. ResultsOf total 553 patients, a number of 107 (19.3%) experienced outcomes. These included 46 cases (25.4%) in group with elevated Lp(a) levels (>30 mg/dL) and 61 cases (16.4%) in non-elevated group (χ2=6.343, p=0.012). The group with elevated Lp(a) was 1.811 times more likely to experience ischemic events than the non-elevated group, each 1 mg/dL increase in Lp(a) resulted in a 1.008-fold increase in the recurrence rate of ischemic events. In addition, sex (male), previous history of coronary heart disease, decreased albumin, elevated very low density lipoprotein cholesterol and poorly controlled risk factors (including blood pressure and blood sugar) were also associated with a high risk of recurrent ischemic events after stent implantation. ConclusionLp(a) elevation was a significant risk factor for ischemic events in symptomatic patients who underwent intracranial or extracranial artery stenting.

Altered Body Composition and Cytokine Production in Patients with Elevated HOMA-IR after SARS-CoV-2 Infection: A 12-Month Longitudinal Study.

Altered body composition and cytokine production due to SARS-CoV-2 antigens may affect homeostasis model assessment for insulin resistance (HOMA-IR) after SARS-CoV-2 infection. To elucidate this phenomenon, we conducted a longitudinal study involving 47 COVID-19 patients, who were followed up for 12 months. During recruitment, body composition and glucose indices were measured, and heparin blood samples were collected for measuring cytokine production. HOMA-IR was considered an elevated or non-elevated group based on the ratio between HOMA-IR at 12 months and 1 month of convalescence. Those with elevated HOMA-IR had a significantly higher body mass index, body fat percentage, and visceral fat rating and had a lower lean mass and lean/fat mass ratio than their counterparts. During the convalescent period, the elevated HOMA-IR group had lower TNFα, IFNγ, IL-2, IL-10, and granzyme B expression levels but had higher TNFα/IL-10, IFNγ/IL-10, IL-2/IL-10, and granzyme B/IL-10 ratios than the other group. The reduced cytokine production and pro-/anti-inflammatory imbalance in patients with elevated HOMA-IR may suggest immune cell dysfunction toward SARS-CoV-2. Patients with elevated HOMA-IR after SARS-CoV-2 infection may experience an increase in BMI and body fat percentage, leading to increased immune dysfunction and chronic inflammatory condition. A nutritional approach and promotion of physical activity may help reduce HOMA-IR and ameliorate glucose indices in these patients.

Association between lipoprotein(a) and long-term outcomes after percutaneous coronary intervention for lesions with in-stent restenosis

ObjectivesThis study aimed to evaluate the association between increased lipoprotein (a) [Lp(a)] and long-term outcomes in patients undergoing percutaneous coronary intervention (PCI) for in-stent restenosis (ISR). BackgroundElevated Lp(a) is demonstrated to be associated with recurrent ischemic events after PCI. However, the impact of Lp(a) in patients with ISR remains undetermined. MethodsBetween January 2017 and December 2018, a total of 2086 patients who underwent PCI for ISR were consecutively enrolled. Patients were categorized as elevated group (> 30 mg/dL, n=834) and non-elevated group (≤ 30 mg/dL, n=1252) according to baseline Lp(a) levels. The primary outcome was the rate of major adverse cardiac events (MACE), defined as a composite endpoint of all-cause death, spontaneous myocardial infarction (MI), or repeat revascularization. ResultsDuring a median follow-up of 36 months, the primary outcome occurred in 202 of 1252 patients (26.7%) in the elevated Lp(a) group and 237 of 834 patients (21.8%) in the non-elevated Lp(a) group (adjusted hazard ratio: 1.31; 95% confidence interval: 1.08-1.58; P = 0.007), driven by higher rate of all-cause death (4.1% vs. 2.5%, P = 0.002 by Log-rank test; aHR: 1.77; 95% CI: 1.07-2.94; P = 0.03) and repeat revascularization (22.3% vs. 19.5%, P = 0.04 by Log-rank test; aHR: 1.18; 95% CI: 0.94-1.49; P = 0.16). Adding continuous or categorical Lp(a) to the Cox model led to a significant improvement in C-statistic, net reclassification, and integrated discrimination. The results were consistent across subgroups. ConclusionsIn the current cohort of patients who underwent PCI for ISR, elevated Lp(a) at baseline is associated with higher risk of long-term MACE.

Networks of C-reactive protein and depression symptoms in patients with stable coronary heart disease: Findings from the Heart and Soul Study.

Research addressing the associations between C-reactive protein (CRP) and depression among patients with stable coronary heart disease (CHD) has produced inconsistent results. This might be attributable to varying associations of CRP with specific depression symptom profiles. We responded to this challenge using various network analysis techniques. A total of 967 outpatients with documented CHD were drawn from the baseline cross-sectional data of the Heart and Soul Study. We first estimated mixed graphical models that included CRP and individual depression symptoms, before and after adjusting for relevant covariates, to explore whether CRP is correlated with specific facets of depression. We also investigated whether CRP levels moderated the associations between specific depression symptoms using moderated network models. Finally, we performed a network comparison test and compared the symptom network properties between non-elevated and elevated CRP groups. In the network model without covariates, CRP was positively associated with fatigue, appetite changes, and psychomotor problems. CRP maintained its negative association with concentration difficulty regardless of covariate adjustment. Few symptom-symptom associations, especially those involving appetite changes, were moderated by CRP. Further, the elevated CRP group showed greater overall symptom connectivity as compared to the non-elevated group. This study segues into CRP-depression relationship with sophisticated methodology.

Increase in skeletal muscle extracellular volume as an under-recognised change detected at cardiac MRI in hypertrophic cardiomyopathy

To explore skeletal muscle change and its correlation with the myocardium in hypertrophic cardiomyopathy (HCM) using cardiac magnetic resonance imaging (cMRI) with T1 mapping and late gadolinium enhancement (LGE). This retrospective study enrolled 50 HCM patients and 35 healthy controls. The extracellular volume (ECV) of the skeletal muscle and myocardium, the presence and absence of LGE of the myocardium, and cardiac troponin T (cTnT), were assessed. In the HCM group, the elevated ECVskeletal group was defined as ECVskeletal >2 standard deviations (SD) above the mean value of the controls. Statistical analyses included Student's t-test, the Mann-Whitney U-test, and linear regression. ECVskeletal in the HCM group was higher than in the control group (mean 13.0 versus 10.9%; p<0.001), with 20 (40%) HCM patients having elevated ECVskeletal (ECVskeletal ≥13.7%). In the HCM group, ECVskeletal had a positive linear correlation with global myocardial ECV (r=0.37, p=0.009). In addition, the elevated ECVskeletal group had a higher cTnT than the non-elevated group (log cTnT, mean 1.55 versus 1.16, p=0.045). Furthermore, segmental myocardial ECV in the elevated ECVskeletal group was higher than in the non-elevated group, despite the presence or absence of myocardial LGE (median 30.1 versus 27.2%; 26.5 versus 24.6%, both p<0.001) or hypertrophy (median 29.0 versus 26.0%; 26.8 versus 24.8%, both p<0.001). In the HCM patients, ECVskeletal was higher than in the healthy controls. Furthermore, some ECVskeletal changes had corresponding changes in the cTnT and myocardium.

CA125 kinetics as a potential biomarker of prognosis in nivolumab monotherapy for patients with advanced gastric cancer and peritoneal metastasis.

445 Background: The ascites develop in large proportion of patients during salvage-line chemotherapy for advanced gastric cancer (AGC). Serum CA125 is reported to be potential biomarker in peritoneal metastasis and associate with prognosis in first-line treatment for AGC. Therefore we aimed to clarify the association between serum CA125 and therapeutic efficacy for AGC treated with third of later-line nivolumab monotherapy (Nivo). Methods: This multicenter retrospective study comprised AGC patients who received Nivo in third line or later setting between Jun. 2015 to May 2019. Patient background and treatment outcome was assessed in CA125 elevated and non-elevated group before Nivo (cut-off, 37 U/ml). The CA125 kinetics after chemotherapy was calculated based on baseline and first measure of CA125. Further, the association between CA125 kinetics and ascites burden during chemotherapy were evaluated based on optimal cut off value calculated receiver operating characteristic (ROC) curve analysis. Results: A total 50 patients from 5 hospitals were assessable. The proportion of poor PS, moderate/severe peritoneal effusion, low albumin was significantly larger in CA125 elevated group (n=29) than those in non-elevated group. The median value of CA125 before Nivo was elevated according to ascites burden (none, 31.0 U/ml; mild, 49.4 U/ml; moderate/severe, 187.0 U/ml; p&lt;0.001). The overall survival was significantly shorter in elevated group than that in non-elevated group (median, 3.2 vs. 9.4 months, p=0.035). After Nivo, first-time measure of CA125 was performed in a median of day 27. The median change of CA125 was correlated with ascites response (CR/PR, 0.04%/day; SD, 2.06%/day; PD, 4.17 %/day, p=0.013). ROC curve analysis showed that the optimal cut-off value of CA125 kinetics for ascites progression was 2.4%/day (specificity 75%, sensitivity 70%). The progression free survival in increased group was significantly shorter than that of non-increased group in patients with peritoneal dissemination (median, 1.4 vs 3.3 months, p=0.016). Conclusions: The serum CA125 before Nivo was associated with ascites burden. Further, CA125 kinetics after Nivo was associated with prognosis in AGC patients with peritoneal dissemination.

CA125 kinetics as a potential biomarker for ascites progression during taxane plus ramucirumab therapy in patients with advanced gastric cancer.

437 Background: Ascites and peritoneal metastases are major interruptive factors in sequential chemotherapy for advanced gastric cancer (AGC), although there are no established markers that predict ascites burden during treatment. Therefore, we aimed to clarify the association between serum CA125 and therapeutic efficacy for AGC treated with taxane plus ramucirumab (TAX/RAM). Methods: This multicenter retrospective study comprised AGC patients who received TAX/RAM in second or third line setting between Jun. 2015 to May 2019. Patient background and treatment outcome was assessed in CA125 elevated and non-elevated group before TAX/RAM (cut-off, 37 U/ml). The CA125 kinetics after chemotherapy was calculated based on baseline and first measure of CA125. Further, the association between early CA125 change and ascites burden during chemotherapy were evaluated based on optimal cut off value calculated receiver operating characteristic (ROC) curve analysis. Results: A total 73 patients from 5 hospitals were assessable. The proportion of poor PS, moderate/severe peritoneal effusion, low albumin was significantly larger in CA125 elevated group (n=31) than those in non-elevated group. The median value of CA125 before TAX/RAM was elevated according to ascites burden (none, 37.5 U/ml; mild, 57.9 U/ml; moderate/severe, 134.8 U/ml; p&lt;0.001). The overall survival was significantly shorter in elevated group than that in non-elevated group (median, 8.2 vs. 14.6 months, p=0.0004). Baseline CA125 elevation and peritoneal metastasis were independent prognostic factors in multivariate analysis. After TAX/RAM, first-time measure of CA125 was performed in a median of day 28. The median change of CA125 was correlated with ascites response (CR/PR, -1.86%/day; SD, 0.28%/day; PD, 2.33 %/day, p&lt;0.001). ROC curve analysis showed that the optimal cut-off value of CA125 kinetics for ascites progression was 0.0067%/day (specificity 74%, sensitivity 100%). The progression free survival in increased group was significantly shorter than that of non-increased group in patients with peritoneal dissemination (median, 2.5 vs 6.1 months, p=0.0008). Conclusions: The serum CA125 before TAX/RAM was associated with ascites burden. Further, early change of CA125 after TAX/RAM was associated with prognosis in AGC patients with peritoneal dissemination. CA125 monitoring may be biomarker in determining timing of treatment change.

Clinical significance of CA125 in unresectable pancreatic cancer treated with first-line chemotherapy.

745 Background: Serum CA125 is a potential biomarker for diagnosis of peritoneal metastasis in gastric cancer. However, its significance of pancreatic cancer (PC) has not been investigated. Therefore, we aimed to clarify association between serum CA125 and ascites burden, and its kinetics during first-line chemotherapy for PC. Methods: This multicenter retrospective study comprised PC patients who received FOLFIRINOX or gemcitabine plus nab-paclitaxel in first-line setting between Jan 2014 and Dec 2021. Patient background and treatment outcome was assessed in CA125 elevated and non-elevated group before chemotherapy. The CA125 kinetics after chemotherapy was calculated based on baseline and first measure of CA125. Further, the association between early CA125 change and clinical response during chemotherapy were evaluated based on optimal cut off value calculated receiver operating characteristic (ROC) curve analysis. Results: A total 109 patients from 3 hospitals were assessable. The overall survival (OS) was significantly shorter in elevated group than that in non-elevated group (median, 10.7 vs. 21.3 months, p = 0.0002). The median value of CA125 before chemotherapy was elevated according to ascites burden (Non, 36U/ml; mild, 173U/ml; moderate/severe, 575U/ml; p &lt; 0.0001). CA125 elevation, CA19-9 elevation, poor performance status and poor glasgow prognostic score were independent prognostic factors in multivariate analysis. After chemotherapy, the median first-time measure of CA125 was performed in day 41. Among patients with peritoneal dissemination, the median change of CA125 was correlated with clinical response (CR/PR, -0.55%/day; SD, -0.24%/day; PD, 3.35%/day, p = 0.004). After chemotherapy, first-time measure of CA125 was performed in a median of day 41. According to the ROC curve analysis, the optimal cut-off value of increase in CA125 for progressive disease was 1.56 %/day (specificity 94.1%, sensitivity 80%). The median PFS and OS were 1.4 and 6.6 months in increased group and 3.3 months and 14.0 months in non-increased group, respectively (p = 0.016 and p = 0.028). Conclusions: CA125 is considered a clinically useful marker in unresectable PC treated with first-line chemotherapy because CA125 above the ULN is a poor prognostic factor for OS and an increased CA125 can be an early predictor of progression in patients with peritoneal dissemination.

High-sensitivity Cardiac Troponin T in Sepsis:Prognostic Value and Risk Factors of Its Elevation

Objective To explore the prognostic value of high-sensitivity cardiac troponin T (hs-cTnT) in predicting mortality within 28 days among sepsis patients,and to investigate the risk factors of hs-cTnT elevation. Methods The clinical and laboratory data of patients with sepsis or septic shock who were hospitalized at the Second Affiliated Hospital of Chongqing Medical University from December 2017 to September 2021 were collected and retrospectively analyzed.The patients were assigned into a hs-cTnT elevated group (hs-cTnT>0.1 ng/ml) and a hs-cTnT non-elevated group (hs-cTnT≤0.1 ng/ml).The prognosis was compared between the two groups and the risk factors of hs-cTnT elevation were determined. Results A total of 225 patients were included in this study,including 49 in hs-cTnT elevated group (21.8%) and 176 in hs-cTnT non-elevated group (78.2%).The receiver operating characteristic curve showed that maximum hs-cTnT had predictive value for death within 28 days (P<0.001).The maximum hs-cTnT showed the area under the receiver operating characteristic curve of 0.767 (95%CI=0.699-0.835),the sensitivity of 62.5%,and the specificity of 79.9%.The mortality within 28 days of hs-cTnT elevated group was higher than that of hs-cTnT non-elevated group (53.1% vs. 17.0%, χ2=26.595, P<0.001).Multivariate Logistic regression analysis revealed that the independent predictors of hs-cTnT elevation were age ≥75.5 years (OR=5.990, 95%CI=2.143-16.742, P=0.001),lactate ≥4.05 mmol/L (OR=4.982,95%CI=1.433-17.315,P=0.012),oxygenation index ≤169.15 mmHg (OR=5.052, 95%CI=1.888-13.514, P=0.001),B-type brain natriuretic peptide precursor ≥6 687.0 pg/ml (OR=5.991, 95%CI=2.226-16.128, P<0.001),fibrinogen ≤2.87 g/L (OR=3.325,95%CI=1.175-9.404, P=0.024),and International Society on Thrombosis and Haemostasis overt disseminated intravascular coagulation score ≥5.5 (OR=7.631, 95%CI=1.157-50.338, P=0.035). Conclusions hs-cTnT showed good performance in predicting mortality within 28 days among the patients with sepsis.Coagulation disorder,microthrombus formation,and myocardial oxygen supply-demand mismatch may be the risk factors of myocardial injury in sepsis.

Retrospective study to examine prognostic value of c-reactive protein (CRP) in patients with surgically resected non-small-cell lung cancer (NSCLC).

e20569 Background: This study evaluated the association between baseline elevated CRP and lung cancer outcomes among adults with NSCLC who underwent surgery in the US. Methods: Optum Clinformatics Data Mart in the US (01/2007-09/2020) was used to identify adults with NSCLC who underwent lung cancer surgery and had at least 1 CRP measurement prior to or &gt; 1 month following the index surgery. Baseline CRP levels were defined as the CRP closest to the index surgery in the pre-surgery cohort, and the CRP at least 1-month after in the post-surgery cohort. The association between elevated CRP (&gt; 10 mg/L) and rate of NSCLC recurrence/risk of death was assessed separately for pre-surgery and post-surgery cohorts using multivariate regressions. The overall trend in CRP measurements over a 5-year period was examined using trend tests among those with persistently elevated CRP. Results: For adults in the pre-surgery cohort who had index lung cancer surgery between 2016-2020 (N = 104), after adjusting for age, sex, National Cancer Institute comorbidity, autoimmune disease, peripheral vascular disease, and smoking status, the adjusted-incidence rate ratio (IRR) for NSCLC recurrence was 2.17 (95% confidence interval [CI]: 1.03, 4.60; p &lt; 0.05) among patients with elevated CRP compared with non-elevated CRP. A similar IRR (2.22 [95% CI: 1.05, 4.70]; p &lt; 0.05) was observed among the 264 patients in the post-surgery cohort. Among the 234 patients in the pre-surgery cohort, there was a near two-fold increase in the risk of all-cause death associated with the elevated than the non-elevated CRP groups (odds ratio [OR]: 1.91 [95% CI: 1.06, 3.42]; p &lt; 0.05), and there was a numerically increased risk associated with elevated baseline CRP for the post-surgery cohort (OR: 1.62 [95% CI: 0.88, 2.97]; p = 0.12). Among those with persistently elevated CRP prior to surgery, we observed a significant overall trend of increased CRP levels over the 5-year period. Conclusions: Using real world data in the US, results suggest that an elevated CRP at baseline is associated with a higher risk of NSCLC recurrence and mortality, for both pre- and post-surgery cohorts. An increasing trend of CRP level within 5 years prior to lung cancer surgery indicates the correlation of CRP (as a marker of inflammation) with tumor development. This study adds to a growing body of literature and may shed light into oncology treatments aimed at suppressing tumor-promoting inflammation.

Abstract 275: The Association Between Elevated Lipoprotein(a) And In-hospital Outcomes

Purpose: Elevated lipoprotein(a), Lpa, has quickly emerged as an independent cardiovascular disease risk factor with increased risk for adverse atherosclerotic Using the National Inpatient Sample (NIS) database, we sought to assess the association of elevated Lp(a) to in-hospital cardiovascular outcomes. Methods: We identified patients with elevated Lpa using ICD-10 code in the NIS data from the year 2019. We compared in-hospital outcomes between elevated and non-elevated Lpa groups before and after propensity score matching. We then performed a regression analysis on the matched cohort. Our predictors of interest were acute myocardial infarction (AMI), cerebrovascular disease (CEVD), peripheral vascular disease (PVD), and a composite outcome (cardiorisk) including, AMI, CEVD, and PVD. Results: In the unmatched cohort, the elevated Lpa group had higher incidences of AMI, CEVD, PVD, and the composite outcome (all p&lt;0.05). However, length of stay and cost of hospitalization did not differ considerably. After propensity score matching, the elevated Lpa group had higher rates of AMI (7.1% vs 1.2%, p&lt;0.001), CEVD (11.2% vs 2.8%, p&lt;0.001), PVD (1.8% vs 0.2%, p=0.021), and composite outcome (20% vs 6%, p&lt;0.01). Elevated Lpa group had longer length of stay 5±5 vs 4±3, p=0.002), and higher cost of hospitalization (69,060 ± 76,028 vs 20,992±15,065, p&lt;0.001). Multivariable regression analysis controlling for common predictors of atheroembolic risk showed higher odds of AMI (2.33, p&lt;0.001), CEVD (1.62, p= 0.002), PVD (2.22, p=0.094), and cardiorisk (1.68, p&lt;0.001) among the elevated Lpa group. Conclusion: Elevated Lpa is associated with a higher incidence of atheroembolic disease in this nationally representative sample and associated with a higher length of stay and healthcare costs. Further research is needed to fully understand its mechanism and possible treatment to reduce adverse cardiovascular outcomes.

Increased Rate of Serum Prealbumin Level after Preoperative Enteral Nutrition as an Indicator of Morbidity in Gastrectomy for Gastric Cancer with Outlet Obstruction.

Preoperative malnutrition is believed to contribute to increased postoperative complications. Preoperative serum prealbumin level was reported to be a predictor of nutritional status and postoperative complications after gastrointestinal surgery, including gastrectomy. Gastric outlet obstruction caused by gastric cancer leads to insufficient nutritional status. However, the impact of preoperative enteral nutrition using naso-jejunal feeding tubes for patients with gastric outlet obstruction is not fully understood. From July 2010 to June 2020, 50 patients with gastric cancer-induced outlet obstruction who underwent gastrectomy following preoperative enteral nutrition via feeding tube were included. We investigated the relationship between changes in nutritional status after preoperative enteral nutrition and postoperative complications. Postoperative complications were defined as grade ≥II based on the Clavien-Dindo classification. The median period of preoperative enteral nutrition was 10days. The median increase rate of the serum prealbumin level was 10.5% (interquartile range, 0.63-38.2%), and patients with an increase rate ≥ 10% were defined as the elevated group. Postoperative morbidity was significantly higher in the non-elevated group (P = 0.0031). Univariate and multivariate analyses showed that an increased rate of the serum prealbumin level was an independent risk factor of postoperative complications for patients with gastric outlet obstruction caused by gastric cancer (P = 0.0025 and P = 0.009, respectively). Preoperative enteral nutrition improved the serum prealbumin level of patients with gastric cancer-induced outlet obstruction, and an increased rate of prealbumin can be an indicator of sufficient preoperative enteral nutrition and decreased postoperative morbidity.

Predictive factors for elevated prostate specific antigen and hematocrit levels during testosterone replacement therapy in patients with testosterone deficiency

Objective: We examined risk factors associated with prostate specific antigen (PSA) and hematocrit (hct) elevation during testosterone replacement therapy (TRT) in patients with testosterone deficiency (TD). Methods: We retrospectively analyzed the medical records of patients receiving TRT for ≥3 months. We investigated the following parameters: age, body mass index, comorbidities, TRT type, TRT duration, pre-TRT prostate volume, pre- and post-TRT serological tests, prostate biopsies, prostate cancer diagnoses, pre- and post-TRT aging male symptom scale scores, hct elevation, and PSA elevation. The patients were divided into two groups based on the PSA elevation status for comparison, following which we analyzed the predictive factors for PSA elevation. They were also divided into two groups based on hct elevation status. Results: The PSA elevation group showed a statistically significantly higher mean age, pre-TRT prostate volume, and PSA level compared to the non-elevation group. The PSA non-elevation group showed a significantly higher percentage of smokers, while the PSA elevation group showed a statistically significantly higher prevalence of benign prostatic hyperplasia (BPH_LUTS). The results demonstrated that a large pre-TRT prostate volume, high pre-TRT PSA levels, BPH_LUTS, and being a non-smoker were the contributing factors for PSA elevation. The hct elevation group showed statistically significantly higher pre-TRT Hb, hct, and post-TRT testosterone levels, and dyslipidemia rates, as well as a non-statistically significant prevalence of testosterone enanthate (TE) and testosterone undecanoate (TU) intramuscular injection. The pre-TRT Hb and hct levels were contributing factors for hct elevation during TRT. TE injection showed marginal statistical significance. Conclusions: We identified large prostate volumes, high PSA levels, BPH_LUTS, and being non-smokers prior to TRT as risk factors for PSA elevation during TRT. Interestingly, we found that TRT-induced hct elevation was likely to occur in patients with high pre-TRT Hb and hct levels. Additionally, the hct levels should be monitored when using TE for TRT.

Etiology of serum vitamin B12 elevation 1 month after bariatric surgery: A case-control study based on China population.

Few studies have reported an increase in vitamin B12 (VitB12) levels after bariatric surgery. This study reports the phenomenon and adverse reactions of serum VitB12 elevation 1 month after surgery and explores the possible etiologies.Retrospective analysis was performed on VitB12 data for 112 patients from January 2018 to October 2019. Then, 87 patients were included between November 2019 and August 2020. They were divided into 2 groups according to the level of VitB12 after surgery, and the demographic and clinical data were analyzed. Then, LASSO regression model analysis and multiple logistic regression analysis were performed to explore the risk factors for VitB12 elevation after surgery.Retrospective data showed that the VitB12 level was significantly increased 1 month after surgery. Comparison of data between the 2 groups found that more patients also had diabetes in the nonelevated group. The postoperative folic acid and VitB12 levels of the elevated group were significantly higher than those of the nonelevated group. More patients had concurrent constipation in the elevated group than in the nonelevated group. Two meaningful variables in LASSO regression analysis were incorporated into the multivariate logistic regression analysis, and constipation was found to be an independent risk factor for the increase in VitB12 after surgery. Of the 199 patients in this study, 111 patients had elevated VitB12 levels after surgery. Among them, 7 patients had peripheral nerve symptoms.Constipation is an independent risk factor for increased VitB12 levels after surgery. High levels of VitB12 may cause some peripheral nerve symptoms. Therefore, it is necessary to pay attention to patients with postoperative constipation, monitor their VitB12 level as soon as possible, and take measures to improve constipation to avoid some adverse reactions caused by elevated VitB12 levels.

Association of Monocyte Chemotactic Protein-1 and Dickkopf-1 with Body Composition and Physical Performance in Community-Dwelling Older Adults in Singapore.

Objective:We aim to determine the association of monocyte chemotactic protein-1 (MCP-1) and dickkopft-1 (DKK-1) as potential biomarkers that may predict changes in body composition and physical performance in healthy older adults from Singapore.Methods:Two-hundred community-dwelling older adults (mean age: 67.9 years; 68.5% females) were classified into elevated versus non-elevated groups based on quintile cut-offs of MCP-1 and DKK-1 levels (156.02 pg/mL and 606.31 pg/mL, respectively). Multiple linear regression was performed to examine the relationship between MCP-1 and DKK-1 with body composition and physical performance, adjusted for age, gender and ethnicity.Results:MCP-1 was significantly associated with higher fat mass, fat mass index, percentage body fat, waist circumference and trunk-limb ratio for fat mass (all p<0.01), and repeated chair stand (p=0.004). DKK-1 was not associated with body composition and physical performance measures. Utilising the Asian Working Group for Sarcopenia (AWGS) 2019 criteria, there were 39 (19.5%) sarcopenia and 161 (80.5%) non-sarcopenia participants respectively, with MCP-1 levels significantly higher in sarcopenia compared with non-sarcopenia (p=0.046), but not for DKK-1 (p=0.525).Conclusions:Elevated MCP-1 are associated with changes in fat composition, physical performance and sarcopenia, suggesting its usefulness in identifying at-risk group with sarcopenic obesity.

Analysis of time-dependent alterations of parameters related to erythrocytes after ipragliflozin initiation.

Sodium-glucose cotransporter 2 (SGLT2) inhibitors often increase the hematocrit. It remains unclear whether this increase would be observed in all patients administered SGLT2 inhibitors, however. We therefore used the data from the previous study and investigated time-dependent alterations of various outcomes related to erythrocytes, erythropoiesis, and clinical outcome in type 2 diabetes subjects (n = 89) treated with ipragliflozin for 16weeks. Among a total of 89 participants, 71 subjects (80.0% of total participants) showed the elevation of the hematocrit and 18 subjects (20.0% of total participants) did not at 16weeks. Although the hematocrit levels at baseline were significantly lower in hematocrit-elevated group than non-elevated group, they reached the same levels 4weeks after the onset of treatment. Binomial logistic regression analysis demonstrated that a lower baseline hematocrit level was related to the elevation of hematocrit at 16weeks. Optimal cutoff hematocrit levels at baseline to predict hematocrit elevation were 46.9% (male) and 41.7% (female) in ROC analysis. Random intercept model analysis revealed the serum erythropoietin level increased in both hematocrit-elevated and non-elevated groups, whereas only the former group showed an increase in the percentage of reticulocytes during the first 4weeks. These results suggest that the ipragliflozin-induced increase in hematocrit which is affected by the baseline hematocrit level is attributable to the responsiveness to, but not to the production of, erythropoietin. Collectively, Ht elevation observed in administration of SGLT2 inhibitors can result from erythropoietin-induced erythropoiesis, which is determined by the pre-treatment Ht level. Trial registration: This trial has been registered with University Hospital Medical Information Network Clinical Trial Registry (UMIN-CTR no. 000015478).

The Relation between Changes in Vitamin D and Vitamin B12 Levels, Body Mass Index and Outcome in Methadone Maintenance Treatment Patients

ABSTRACT Patients’ Body Mass Index (BMI) increase during methadone maintenance treatment (MMT), and both Vitamins D and B12 deficiencies may be associated with BMI. We studied the relations between BMI, these vitamins and treatment outcome in patients with opioid use disorder receiving MMT. Vitamin B12 levels were available for 272 patients and Vitamin D levels were available for 260 patients. Of those 112 and 80 respectively had two measures (at admission or thereafter, and while stabilized or after one year in treatment). Patients’ BMI levels and long-term retention were analyzed. Vitamin B12 was lower in patients abusing cocaine/amphetamine on admission. Vitamin D did not change over time, but a significant weight gain could be observed in 38 patients whose vitamin D was elevated compared to 42 whose levels were not, (25.4 ± 4.8 to 28.8 ± 5.2 vs. 24.3 ± 3.7 to 25.5 ± 4.0, p(Time) < 0.0005, p(Group) = 0.03, p(interaction) = 0.02). BMI changes correlated with vitamin D levels change (r = 0.26, p = .04). Longer cumulative retention was observed among the elevated vitamin D group (8.1 years, 95% CI 6.3–9.8) in comparison with the non-elevated group (4.8y 95% CI 3.6–6.1, Kaplan Meier, p = .02). Stimulants misuse was associated with low B12 levels. Vitamin D elevation is associated with weight gain and longer retention in treatment.

Leg raise can detect exercise-induced pulmonary arterial wedge pressure elevation

Abstract Background Exercise-induced elevation of pulmonary arterial wedge pressure (PAWP) may show preclinical or exercise-induced left ventricular diastolic dysfunction. Invasive hemodynamic assessment during provocative maneuvers, like exercise and volume challenge, in these patients allows greater sensitivity to diagnose or exclude HFpEF. The aim of this study was to examine how the leg raise, which is a simple way to increase preload, can detect exercise-induced PAWP elevation. Methods Four hundred seventy-nine patients (60±14y.o, mean pulmonary arterial pressure (PAP) 19mmHg, PAWP 8mmHg, CTEPH /IPAH/CTD-PH/SOB unknown reason: 357/56/38/28pts) with near-normal PAP and normal PAWP at rest underwent symptom-limited exercise test using supine cycle ergometer with right heart catheter. Exercise-induced elevation in PAWP of over 20mmHg was defined as exercise-induced elevation group. Results ΔPAWP (after leg raise - rest) in the exercise-induced elevation group was significantly higher (6.0±4.1 vs. 2.7±3.9mmHg, p&amp;lt;0.001, in the older (age≥60y.o) group (n=276); 3.4±3.5 vs. 1.9±3.4mmHg, p&amp;lt;0.001, in the younger (age&amp;lt;60y.o) group (n=203)) than that in the non-elevation group after legs raise for cycle ergometer exercise. The area under the ROC curve for ΔPAWP was 0.72 (95% CI: 0.65–0.78) in the older and 0.64 (95% CI: 0.53–0.75) in the younger. In the older, the cut-off value for detect exercise-induced PAWP elevation of ΔPAWP was 4mmHg, with 72% sensitivity and 58% specificity. On the other hand, in the younger, the cut-off value was 3mmHg, with 69% sensitivity and 59% specificity. Conclusion Leg raise can easily detect occult left ventricular diastolic dysfunction. Funding Acknowledgement Type of funding source: None