Surgical versus transcatheter aortic valve replacement in patients with prior coronary artery bypass graft surgery.

Although surgical resection is the standard of care for early-stage non-small cell lung cancer, frailty influences treatment decisions. We evaluated the prognostic utility of the Veterans Affairs Frailty Index, a claims-based assessment tool, among veterans undergoing resection for stage I non-small cell lung cancer. We conducted a retrospective cohort study of veterans who underwent curative-intent surgery for stage I non-small cell lung cancer in the Veterans Health Administration from 2006 to 2020. Using the Veterans Affairs Frailty Index, frailty was categorized as follows: nonfrail (≤0.1), prefrail (0.1-0.2), mildly frail (0.2-0.3), moderately frail (0.3-0.4), and severely frail (>0.4). The primary outcome was overall survival, assessed using multivariable Cox regression. Secondary outcomes included major complications, prolonged hospitalization, 30-day readmission, 90-day mortality, and recurrence. Among 12,271 veterans, 7.7% were severely frail. Compared with nonfrail patients, severely frail patients were older (mean age 70.3 years vs 64.7 years; P < .001) and were more likely to undergo minimally invasive surgery (57.7% vs 37.8%) and sublobar resection (41.2% vs 22.3%) (all P < .001). Severe frailty was independently associated with higher risk of major complications (adjusted odds ratio 2.85, 95% confidence interval 2.18-3.71), prolonged hospitalization (adjusted odds ratio 2.67), 30-day readmission (adjusted odds ratio 1.76), 90-day mortality (adjusted odds ratio 2.87), and worse overall survival (adjusted hazard ratio 2.20, 95% confidence interval 1.97-2.46; all P < .001). Recurrence was not significantly associated with frailty (adjusted hazard ratio 0.87; P = .410). Frailty, as measured by the Veterans Affairs Frailty Index, independently predicts adverse postoperative and survival outcomes following resection for stage I non-small cell lung cancer. Preoperative frailty assessment may improve risk stratification and guide surgical decision making.

Adverse childhood experiences and loneliness trajectory in middle-aged and older adults: A network analysis approach.

Comparative midterm ramifications of one anastomosis gastric bypass, Roux-en-Y gastric bypass, and sleeve gastrectomy: A retrospective cohort study of 6,234 patients.

National trends in conduit selection for redo coronary arterial bypass grafting.

Effectiveness of pneumococcal conjugate vaccines against invasive pneumococcal disease in Vietnamese children prior to national introduction: A matched case-control study.

Earlier age at menarche may influence mental health but less is known of other measures of pubertal development. We aimed to investigate general mental health consequences of altered timing and tempo of several pubertal milestones in adolescents from the population-based Danish National Birth Cohort (DNBC). Information on pubertal development (Tanner stages, age at menarche, age at first ejaculation, and voice break), was provided half-yearly throughout puberty in 6941 adolescent females and 6267 adolescent males. Timing (earlier, average, later) and tempo (faster, average, slower) of puberty were derived using non-linear mixed effect growth models and analysed as categorical and continuous variables. Outcomes included self-rated health obtained from the DNBC 18-year follow-up, and redemption of any prescribed psychotropic medication or any psychiatric diagnosis obtained from the Danish registers up to age 19years. Adjusted odds ratios were estimated using logistic regression. Earlier pubertal timing and faster pubertal tempo were associated with higher odds, whereas later pubertal timing and slower pubertal tempo were associated with lower odds of the mental health outcomes, ranging from poor self-rated health to redeeming any psychotropic medication and receiving a psychiatric diagnosis. Associations were strongest in female adolescents. Altered pubertal development was associated with all unfavorable mental health outcomes. Vulnerable adolescents at increased risk of poor mental health due to earlier pubertal timing or faster pubertal tempo should be identified with the potential to introduce earlier interventions and support preventive actions for these adolescents.

Technology-assisted total hip arthroplasty (THA)-including computer-navigated and robotic-assisted techniques-has emerged as a strategy to enhance component alignment and potentially improve postoperative outcomes. Although prior studies have described increasing utilization, contemporary trends and associated complication rates remain underexplored. A retrospective cohort study was conducted using a large national database to identify patients who underwent primary elective THA between 2010 and 2023. Patients were stratified into conventional vs technology-assisted THA groups, with the latter defined by the use of computer navigation or robotic assistance. Annual utilization trends were evaluated using linear regression, and 90-day postoperative complications were compared using multivariate logistic regression after adjusting for demographic, clinical, and regional factors. Among 1,062,597 patients undergoing primary elective THA, 4% received technology-assisted procedures. Utilization increased from 1.2% in 2010 to 12% in 2023-a 927% relative increase. Regional variation was notable, with highest utilization in the Northeast and the lowest in the Midwest. Technology-assisted THA was associated with lower odds of 90-day complications (5.36% vs 6.26%; adjusted odds ratio [OR]: 0.77; 95% confidence interval [CI]: 0.75-0.80), particularly reduced odds of dislocation (OR: 0.64; 95% CI: 0.60-0.69) and periprosthetic joint infection, though with higher odds of wound dehiscence (OR: 1.15; 95% CI: 1.07-1.23). Utilization of technology-assisted THA has increased substantially across the United States, accompanied by improved short-term outcomes, most notably decreased dislocation. These findings support the potential clinical benefits of surgical technology in THA, while underscoring the need for ongoing evaluation of long-term results.

Same day discharge after minimally invasive interval debulking surgery in advanced stage ovarian cancer.

Despite the widespread implementation of vaccination programs, pertussis continues to spread and remains a major health threat to infants. The present study aimed to identify risk factors of severe pertussis in children to inform clinical decision-making and the development of prevention strategies. This retrospective cohort study included data from paediatric patients diagnosed with pertussis at Beijing You'an Hospital, Capital Medical University (Beijing, China), between January 2006 and December 2023. Multivariable logistic regression was performed to identify independent predictors of severe pertussis, and receiver operating characteristic (ROC) analysis was used to assess discriminative performance. Data from 219 children with pertussis were divided in 2 groups according to predefined clinical criteria: severe (n = 21) and non-severe (n = 198). Compared with non-severe cases, severe cases experienced longer hospital stays (median 12 versus [vs.] 8 days) and higher rates of fever, cyanosis, sputum production, and respiratory distress. Marked inflammatory differences were observed, as follows: higher neutrophil counts (median 6.83 vs. 3.65 ×10⁹/L); elevated C-reactive protein (median 3.50 vs. 1.00 mg/L); procalcitonin (median 0.12 vs. 0.04 ng/mL); increased neutrophil-to-lymphocyte ratio (NLR; median 0.61 vs. 0.29); and a lower lymphocyte percentage (median 56.9 % vs. 69.5 %) (all p < 0.05). Multivariable analysis identified elevated NLR as an independent predictor of severe pertussis (adjusted odds ratio [OR] 1.884; 95 % confidence interval [CI] 1.157-3.066; P = 0.011). ROC curve analysis yielded an area under the curve (AUC) of 0.745 (95 % CI 0.640-0.850), with an optimal NLR cut-off of 0.475, yielding a sensitivity of 66.7 % and a specificity of 75.5 %. Elevated NLR was an independent predictor of severe pertussis in children. Future multicentre prospective studies with standardised follow-up periods are warranted to validate these findings.

Endovascular treatment for non-acute intracranial vertebrobasilar artery occlusion in Chinese elderly: Efficacy and safety outcomes.

Treatment outcomes and drug-related adverse events across four short-course RR-TB regimens in South Africa: A retrospective analysis.

Individuals affected by chronic pain often have greater pain sensitivity compared to pain-free subjects, but there is a lack of population-based evidence in this regard. The factors playing a role in this relationship are rarely examined. The aims were to evaluate 1) whether pressure pain sensitivity is associated with a) the presence of musculoskeletal (MSK) pain and b) worse pain and 2) whether sex and the presence of chronic diseases moderate these associations. This population-based Northern Finland Birth Cohort 1966 study obtained data on pain frequency (daily, nondaily, and absent), number of pain sites (range 1-8), bothersomeness of pain (Numerical Rating Scale [NRS]-11), and intensity (NRS-11) from 5178 participants (43% males) aged 46 born in 1966. Measured pressure pain threshold (PPT) and pressure pain tolerance (PPTol) were dichotomized as the lowest quartile vs. the other quartiles (the reference). Logistic and linear regressions with adjustments were utilized. Lower PPT and PPTol were associated with daily MSK pain only among females (adjusted odds ratio 1.26, 95% confidence interval 1.00-1.58 for PPT; 1.29, 1.02-1.61 for PPTol). A positive relationship with bothersomeness of pain among individuals with daily or nondaily MSK pain was observed only among females. After stratification by chronic diseases, the associations between PPT/PPTol and daily MSK pain remained significant only among females with chronic diseases. The associations between pressure pain sensitivity and MSK pain varied according to sex and presence of chronic diseases. However, clinical relevance of our findings can be questioned.

Prisons offer a critical opportunity for hepatitis C virus (HCV) elimination, yet current data from Danish correctional facilities are sparse. We conducted a cross-sectional study in 16 prisons across Eastern Denmark between October 2022 and August 2024, enrolling 651 incarcerated individuals. All participants underwent HCV antibody and RNA testing using dried blood spots and completed a bio-behavioural risk survey. The prevalence of HCV antibody and HCV RNA was 4.2% (n = 26) and 2.0% (n = 13) respectively. HCV exposure was most prevalent among individuals with a history of injecting drug use (56.4%), women (11.3%) and foreign-born individuals (6.7%). In multivariable logistic regression, HCV exposure was significantly associated with injecting drug use (adjusted odds ratio [aOR] 209.11, 95% confidence interval [CI]: 36.16-1209.27), female sex (male vs. female: aOR 0.18, 95% CI: 0.05-0.60) and being born in a low-prevalence country (aOR 6.22, 95% CI: 1.64-23.61). We observed substantial site-level variation and care gaps that disproportionately affect marginalised groups. These findings support the implementation of targeted HCV screening at prison intake, along with facility-specific and population-tailored interventions, as essential strategies for achieving Denmark's commitment to the World Health Organization's HCV elimination goal.

Associations of adverse childhood experiences, sexual identity and sexual risk indicators with HPV vaccination uptake in Denmark - A nationwide epidemiological study.

To investigate the association between the initiation of strong chū-hai-an inexpensive Japanese ready-to-drink beverage with high-alcohol-content-consumption and the newly incident hazardous and harmful alcohol use among individuals who consume alcohol. This cohort study is based on a three-year longitudinal internet survey conducted in Japan from 2022 to 2024. Respondents who completed all three annual surveys, did not drink strong chū-hai in 2022, and consumed alcohol without presenting hazardous or harmful alcohol use in both 2022 and 2023, were included. The outcome was defined as having newly developed hazardous and harmful alcohol use in 2024, defined as a score of ≥ 8 on the Alcohol Use Identification Test. We fitted a multivariable logistic regression model to examine confounder-adjusted association between initiating strong chū-hai consumption and the incidence of hazardous and harmful alcohol use. Of 5358 respondents from 33,000 surveyed in 2022, approximately 10 % (n = 533) initiated strong chū-hai consumption in 2023. In 2024, the prevalence of hazardous and harmful alcohol use was higher for those who initiated strong chū-hai consumption (7.7 %) than those who did not (3.1 %). Multivariable analysis revealed that initiating strong chū-hai consumption was associated with higher odds of hazardous and harmful alcohol use the year following (adjusted odds ratio 1.90, 95 % confidence interval 1.19-3.06, p = 0.008). The initiation of strong chū-hai consumption was associated with the incidence of hazardous and harmful alcohol use. Considering the global increase in sales of ready-to-drink alcoholic beverages, our findings serve as an important caution for policymakers worldwide.

Preoperative anxiety is associated with postoperative cardiovascular events, extubation delay, and pain in patients undergoing cardiac surgery: A prospective observational study in Taiwan.

Sex differences in blood pressure (BP) regulation may modify associations between BP variability (BPV) and hypertension-mediated organ damage (HMOD), but organ-specific effects remain unclear. We studied 398 hypertensive patients from a multicenter home BP monitoring registry. The office-home BP difference (ΔBP = office-home) was analyzed as a single continuous exposure variable, with positive values indicating the white-coat effect and negative values indicating the masked effect. Multivariable regression examined sex-specific associations of BPV patterns with HMOD, including electrocardiographic left ventricular hypertrophy (ECG-LVH) and microalbuminuria/proteinuria. Women demonstrated higher home systolic BPV than men despite similar mean BP levels (P < .01). Office BP was the primary determinant of white-coat phenotypes (office SBP: adjusted odds ratio [aOR] 1.29 [95% CI: 1.22-1.37]; office DBP: aOR 1.27 [1.19-1.37], both P < .01), while home BP predicted masked phenotype (home SBP: aOR 1.23 [1.12-1.39]; home DBP: aOR 1.34 [1.23-1.48], both P < .01). White-coat effects showed protective associations with total HMOD (systolic aOR 0.97 [0.94-1.00], P < .05), while office BPV demonstrated consistent positive associations (systolic aOR 1.10 [1.05-1.16]; diastolic aOR 1.12 [1.05-1.20], both P < .01). Critically, significantly sex interaction emerged for ECG-LVH, while microalbuminuria/proteinuria showed consistent associations across sexes. Sex fundamentally modifies BP patterns-HMOD relationships in an organ-specific manner. Cardiac target organ damage requires sex-attentive monitoring approaches, while renal damage shows universal associations with office BPV. These findings support precision medicine approaches to hypertension management incorporating sex-specific BP assessment strategies.

Introduction: Multidrug-resistant (MDR) Pseudomonas aeruginosa poses a major therapeutic challenge in tertiary-care settings, necessitating local, Clinical and Laboratory Standards Institute (CLSI) -anchored susceptibility data for empiric therapy and stewardship. This study characterises Ceftazidime– Avibactam (CZA) activity and Minimum Inhibitory Concentration (MIC) distribution to support stewardship and local guideline updates Aim: To evaluate the in-vitro activity of CZA against MDR Pseudomonas aeruginosa clinical isolates from a tertiary care hospital in North India. Materials and Methods: This was a hospital-based, crosssectional study conducted in the Bacteriology Division, Postgraduate Department of Microbiology, Government Medical College, Srinagar, Jammu and Kashmir, India, from January 2022 to December 2022 and included 108 non duplicate MDR Pseudomonas aeruginosa clinical isolates. Standardised workflows encompassed specimen culture and identification, Kirby-Bauer disc diffusion, and ceftazidime-avibactam MIC determination by E-test interpreted per CLSI M100 (2022), while demographic parameters recorded for context included age group and gender. Susceptibility was reported as proportions, and predictors of CZA non susceptibility were estimated using multivariable logistic regression. A p-value of &lt;0.05 was considered statistically significant. Results: Ceftazidime-Avibactam susceptibility was 63/108 (58.38%) and exceeded most β-lactam comparators, while aztreonam showed the highest susceptibility at 98/108 (90.74%). The MIC distribution clustered at 2-8 µg/mL with a peak at 8 µg/ mL. In multivariable modelling, burn diagnosis {adjusted Odds Ratio (aOR)=2.15; 95% Confidence Interval (CI) 1.05-4.41}, carbapenem non susceptibility (aOR=2.72; 95% CI 1.34-5.51), and ceftazidime non susceptibility (aOR=2.08; 95% CI 1.01- 4.29) independently predicted CZA non susceptibility. Conclusion: Ceftazidime-avibactam was the most active among core antipseudomonal β-lactams, while aztreonam showed the highest overall susceptibility. The MIC histogram peaked at 8 µg/mL, with most isolates clustering between 2-8 µg/mL. Burn diagnosis, carbapenem non susceptibility, and ceftazidime non susceptibility independently predicted CZA non susceptibility

In this study, we assessed the association of modern systemic hormonal contraception (HC), including newly introduced estradiol-containing combined oral contraceptives, with major adverse cardiovascular events (MACE): myocardial infarction [MI] and ischemic stroke [IS], during 2018-2019. A prospective registry-based cohort study including all 15-49-year-old women residing in Finland in 2017, using HC. We identified women from the national prescription register and incident cases of MACE from the national patient register, yielding 584,236 women and 1167,685 person-years. We analysed cases and their 1:4 age-matched controls in a nested case-control design assessing the association between use vs. non-use of different HC and risk of MACE. Altogether 19.1% of women used combined hormonal contraceptives (CHC), 8.0% ethinylestradiol (EE) and 3.7% estradiol (E2) containing pills while 7.5% used progestin-only-pills (POP). We recorded altogether 334 cases of MACE (84 MI and 250 IS), with an incidence rate of 28.6/100,000 person-years (7.2/100,000 for MI and 21.4/100,000 for IS). Compared to non-use of HC, the adjusted odds ratios (95% CI) of MACE were 1.24 (0.78 - 1.96) and 1.37 (0.73- 2.57) among users of EE and E2 containing HC, and 1.04 (0.64 -1.71) among users of POP. We found no increased risk of MACE associated with use of CHCs containing either EE or E2, or with POP, compared to non-use. We speculate that the cardiovascular safety of modern use of HC is linked both to improved safety of modern contraceptives and their appropriate use. The present findings are reassuring concerning the cardiovascular safety of modern HC, suggesting that use of modern hormonal contraceptives, when aligned with current guidelines, does not significantly increase the risk of MACE.