Prospective Follow-up Cohort Study Research Articles

The Chinese visceral adiposity index: a novel indicator more closely related to cardiovascular disease than other abdominal obesity indices among postmenopausal women

BackgroundSeveral abdominal obesity indices including waist circumference (WC), waist–hip ratio (WHR), visceral adiposity index (VAI), lipid accumulation product (LAP), and Chinese visceral adiposity index (CVAI) were considered effective and useful predictive markers for cardiovascular disease (CVD) in general populations or diabetic populations. However, studies investigating the associations between these indices among postmenopausal women are limited. Our study aimed to investigate the associations of the five indices with incident CVD and compare the predictive performance of CVAI with other abdominal obesity indices among postmenopausal women.MethodsA total of 1252 postmenopausal women without CVD at baseline were analyzed in our investigation based on a 10-year follow-up prospective cohort study. Link of each abdominal obesity index with CVD were assessed by the Cox regression analysis and the Kaplan–Meier curve. The receiver operating characteristic (ROC) curves were drawn to compare the predictive ability for CVD.ResultsDuring the median follow-up of 120.53 months, 121 participants newly developed CVD. Compared to quartile 1 of LAP and CVAI, quartile 4 had increased risk to develop CVD after fully adjusted among postmenopausal women. When WC, VAI and CVAI considered as continuous variables, significant increased hazard ratios (HRs) for developing CVD were observed. The areas under the curve (AUC) of CVAI (0.632) was greatly higher than other indices (WC: 0.580, WHR: 0.538, LAP: 0.573, VAI: 0.540 respectively).ConclusionsThis study suggested that the abdominal obesity indices were associated with the risk of CVD excluded WHR and highlighted that CVAI might be the most valuable abdominal obesity indicator for identifying the high risk of CVD in Chinese postmenopausal women.

Effect of various active reminders via mobile phone on cooperation of orthodontic teenage patients regarding oral hygiene and ClassII elastics use : Athree-month follow-up prospective cohort study.

The purpose of this prospective cohort study was to assess the impact of reminders via mobile phone, such as text messages or video/multimedia images, on orthodontic patients' cooperation with regard to oral hygiene and the use of ClassII intermaxillary elastics. The study included 124 orthodontic patients aged 12-20years (mean age14.06 ± 2.0 years, 63females and 61males). The patients were divided into two groups: group1 (n = 56) was evaluated for oral hygiene, while group2 (n = 68) was evaluated for the use of ClassII intermaxillary elastics. Each main group was divided into three subgroups: text message group, video message group, and control group. Specific messages were sent to the participants in the study groups twice aweek for 12weeks. Data were collected at the beginning of the study (T0), after 6weeks (T1), and 12weeks (T2) and compared to determine the impact of the reminders. Oral hygiene was evaluated using plaque and gingival index scores, and the use of ClassII elastics was evaluated using digital model measurements. Between-subject comparisons were performed using Kruskal-Wallis or one-way analysis of variance (ANOVA). For within-subject comparisons (T0-T1, T1-T2, and T0-T2 time intervals), one-way repeated measures ANOVA or Friedman test was performed. There was no significant difference between the control group (1.49 ± 0.22) and the message groups (video: 1.58 ± 0.34 and text: 1.51 ± 0.28) in terms of plaque index scores and gingival index (control: 1.56 ± 0.26, text: 1.51 ± 0.36, video: 1.52 ± 0.26) scores. However, in the intragroup comparison, it was observed that both plaque index scores and gingival index scores at T0, T1, and T2 increased for both the study and control groups. While there was no difference between the subgroups in overjet measurement at T0 (control: 3.46 ± 1.20, video: 3.34 ± 1.20, text: 2.73 ± 1.03; p = 0.51), there was asignificant difference at T2 (control: 2.62 ± 0.85, video: 2.32 ± 1.41, text: 1.48 ± 0.72, p < 0.01). Mobile active reminders had no effect on improving oral hygiene. Despite repeated reminders, hygiene worsened over time. The use of ClassII elastics seemed to have increased as aresult of the mobile reminders.

Body image and pelvic floor dysfunction in pregnancy and postpartum: A prospective one-year follow-up cohort study.

To determine the prevalence of pelvic floor dysfunction (PFD) among pregnant women, their clustering and their association with body image disturbance (BID) up to 1 year postpartum. Monocentric prospective cohort study. University Hospitals Leuven. Pregnant women attending for pregnancy care, first assessed prior to 14 weeks of gestation and agreeing to follow-up until 1 year postpartum. Standardised questionnaires reporting on PFD and BID at 12-14 and 28-32 weeks of gestation, and again at 6-8 weeks and 1 year postpartum. We calculated the prevalence of PFD, how the cases clustered and how the cases correlated with BID using a linear mixed-model analysis. A minimum of 174 women with complete follow-up were required. The questionnaires used were the International Consultation on Incontinence Questionnaire - Urinary Incontinence Short Form (ICIQ-UI SF), St. Mark's Incontinence Score (SMIS), Patient Assessment of Constipation Symptoms (PAC-SYM), Pelvic Organ Prolapse Distress Inventory (POPDI), Pelvic Organ Prolapse/Incontinence Sexual Questionnaire IUGA Revised (PISQ-IR) and the Body Image Disturbance Questionnaire (BIDQ). Out of 208 women, 92.8% reported one or multiple symptoms of PFD at 28-32 weeks of gestation, dropping to 73.6% by 1 year postpartum. The most common symptoms were constipation (65.3% at 28-32 weeks of gestation and 42.8% at 1 year postpartum) and urinary incontinence (56.8% at 28-32 weeks of gestation and 35.1% at 1 year postpartum). After correcting for body mass index, parity and mode of delivery, the severity of BID was associated with the ICIQ-UI SF score (β = 0.016, range 0.007-0.024), the PAC-SYM score (β = 0.006, range 0.002-0.011) and the POPDI score (β = 0.009, range 0.005-0.012), but not with the SMIS score (β = 0.015, range -0.001 to 0.031) or the PISQ-IR score, in sexually active women. Urinary incontinence, constipation and symptoms of prolapse have a measurable impact on BID.

Number of Teeth and Dementia-free Life Expectancy: A 10-Year Follow-Up Study from the Japan Gerontological Evaluation Study

ObjectivesPrevious studies have reported that tooth loss is associated with an increased risk of dementia; however, few have explored the association between number of teeth and dementia-free and total life expectancies. We investigated whether having more teeth is associated with longer dementia-free and total life expectancies. DesignA 10-year follow-up prospective cohort study from 2010 to 2020. Setting and ParticipantsFunctionally independent older adults aged ≥65 years living in 9 municipalities in Japan. MethodsThe exposure was the number of teeth (≥20, 10–19, 1–9, and 0). Dementia onset and mortality within the 10-year follow-up were used as the outcome. Dementia-free and total life expectancies according to the number of teeth were derived from multistate modeling estimates. ResultsA total of 44,083 participants were included (men: 46.8%). The mean age was 73.7 years [standard deviation (SD) = 6.0]. During follow-up, 17.3% and 21.4% of the participants experienced the onset of dementia and death, respectively. Having fewer teeth was associated with dementia [hazard ratio (HR), 1.14; 95% confidence interval (CI), 1.07–1.22, 10–19 teeth; HR, 1.15; 95% CI, 1.08–1.22, 1–9 teeth; HR, 1.13; 95% CI, 1.05–1.21, 0 teeth] and death (HR, 1.13; 95% CI, 1.05–1.22, 10–19 teeth; HR, 1.27; 95% CI, 1.19–1.37, 1–9 teeth; HR, 1.47; 95% CI, 1.36–1.59, 0 teeth) compared with having ≥20 teeth. Dementia-free life expectancies at the age of 65 years were 16.43 years and 18.88 years with ≥20 teeth, and 14.40 years and 17.12 years with 0 teeth for men and women, respectively. The total life expectancies at the age of 65 were 17.84 years and 22.03 years with ≥20 teeth, and 15.42 years and 19.79 years with 0 teeth for men and women, respectively. Conclusions and ImplicationsHaving more teeth was associated with longer dementia-free and total life expectancies.

Differential effects of low or high-fat dairy and fat derived from dairy products on MASLD

Background & AimsMetabolic dysfunction-associated steatotic liver disease (MASLD) is strongly related to nutrition. However, only a few human and animal studies tested MASLD's association with dairy consumption and the effect of milk fat on liver damage. Therefore, we aimed to test the association of dairy product consumption with MASLD incidence and fibrosis markers in humans, and the effect of milk fat versus other fats in animal studies. MethodsA prospective 7-year follow-up cohort study. MASLD was determined by ultrasonography or controlled attenuation parameter (CAP), and liver fibrosis by FibroTest or Fibroscan. C57BL/6j male mice 6 weeks old were fed for 12 weeks with high-fat diets based on lard, soybean oil, and milk fat. Metabolic impairment was assessed during the experiment, serum advanced glycation end-products (AGEs) and liver damage were evaluated. ResultsIn the cohort, 316 subjects were included. In multivariable analysis, high consumption of low-medium fat low-sugar dairy products (g/d above the baseline gender-specific median) was associated with a lower risk for MASLD incidence (OR=0.42, 0.18-0.95, P=0.037) or incidence/persistence at follow-up (OR=0.58, 0.34-0.97, P=0.039). Constantly high consumption of high-fat low-sugar dairy products was associated with greater odds for new onset/persistence of MASLD. Neither low-medium nor high-fat dairy consumption was related to fibrosis markers. In mice, all high-fat diets induced similar weight gain and steatosis and did not affect liver enzymes. Milk fat increases serum cholesterol and AGEs levels more than lard or soybean oil. ConclusionLow-medium fat low-sugar dairy products may be protective and should be preferred over high-fat dairy to prevent MASLD. High-fat diets from different fat sources with a wide spectrum of fatty acid saturation content are equally deleterious. Impact and implications• MASLD is related to nutrition, but evidence of an association between high and low-fat dairy products is lacking, therefore, we elaborated on this association by performing mice and human studies.• For MASLD prevention, a differential effect of types of dairy products should be considered: low-medium fat low-sugar dairy products were found to be protective, in contrast to high-fat dairy and generally high-fat diets which may be harmful.• It may be advised to prefer low-fat low-sugar dairy products and minimize high-fat dairy products, but more evidence is needed to allow generalizability of our findings.

Percutaneous distal bicortical proximal phalanx osteotomy for second toe deformities – A two-year prospective cohort study

PurposeThe main purpose of our study was to evaluate satisfaction, recurrence, bone union and other complications after a minimum of two years follow-up in patients who had percutaneous claw and hammer (CHT) second toe correction utilizing a novel distal and bicortical proximal phalanx osteotomy (DBPPO). MethodsA minimum two-year follow-up prospective cohort study was conducted on consecutive patients with symptomatic CHT deformities of the second toe corrected with percutaneous surgery. Primary outcomes included satisfaction, recurrence, bony union, and other complication rates specific to the second toe deformity correction. Secondary outcomes included Metatarsophalangeal-Interphalangeal AOFAS scale and Visual Analogue Scale (VAS). ResultsBetween January and October 2020, 34 patients (43 feet) were clinically and radiologically evaluated pre and postoperatively at a mean of 26.6 months. Thirty-eight feet (88.4 %) were satisfied or very satisfied with their second toe deformity correction and 41 feet (95.3 %) would undergo surgery on this toe again. No deformity recurrence requiring revision was found. There were two complications (4.7 %): one toe (2.3 %) with persistent numbness and one (2.3 %) had a simple infection that resolved with oral antibiotics. All 43 s toe osteotomies demonstrated bony consolidation. Stiffness was reported in nine second toes (20.9 %), seven of them (77.8 %) having a rigid pre-operative deformity. Secondary outcomes demonstrated significant improvement in the mean ( ± standard deviation) AOFAS score which increased from 47.5 ± 17.9 preoperatively to 95.7 ± 7.7 postoperatively (p < .001). Mean VAS significantly improved from 4.9 ± 2.5 preoperatively to 0.3 ± 1.3 postoperatively (p < .001). ConclusionPercutaneous treatment of claw and hammer second toe deformities utilizing a DBPPO resulted in high levels of satisfaction with bony consolidation, no recurrence and low complication rates at two years follow-up.Level of evidence: Level II – Prospective cohort study

#3007 Association between sarcopenia and clinical outcomes in patients on maintenance hemodialysis

Abstract Background and Aims Sarcopenia is a generalized skeletal muscle disorder characterized by the progressive loss of skeletal muscle mass, strength, and function, resulting in worse quality of life and increased mortality. Chronic kidney disease and hemodialysis (HD) favor the development of sarcopenia; however, factors associated with sarcopenia in HD patients have not been well-studied. This study aimed to determine the prevalence and risk factors for sarcopenia in HD patients and to analyze the relationship between sarcopenia and overall morbidity and mortality. Method We conducted short-term follow-up prospective cohort study among maintenance HD patients. Hand Grip Strength was measured by a resisted hand-held dynamometer to identify muscle strength and Bioimpedance Spectroscopy to calculate appendicular skeletal muscle mass (ASM). Finally, appendicular skeletal muscle index (ASMI) was calculated as ASM (kg) divided by weight squared (m2). Patients were categorized as sarcopenic or non-sarcopenic using Revised European Working Group criteria (EWGSOP2). Low muscle mass was defined as an ASMI value of&amp;lt;7.00 kg/m2 for men and&amp;lt;5.40 kg/m2 for women; low muscle strength was defined as a hand grip strength of&amp;lt;28 kg for men and&amp;lt;18 kg for women. Results Our study enrolled 176 adult HD patients (60% male, 56.1 ± 14.8 years of age). Median follow-up was 15.9 (interquartile range [IQR] 8.6–21) months. Sarcopenia was present in 32.5 % of males and 28% of female patients and associated with older age (55.2 ± 13.4 vs. 64.0 ± 7.3, p&amp;lt;0.001), lower body mass index (25.3 ± 1.3 vs. 22.8 ± 3.1 kg/m2, p&amp;lt;0.05), longer dialysis vintage (9.2 ± 1.1 vs. 6.2 ± 1.9 years, p&amp;lt;0.001) lower Kt/V and lower serum phosphorus and albumin levels (p = 0.037, p = 0.042 and p = 0.048, respectively). In the multivariate analysis, the sarcopenic group had a significantly higher risk for all causes hospitalization than the non-sarcopenic group after adjusting for age and gender (OR 3.92, (95%CI 1.21–12.53, p = 0.031)). Sarcopenia was significantly associated with higher mortality risk (adjusted OR 1.76 (95% CI 1.32 to 2.67)), cardiovascular (adjusted OR 3.31 (95% CI 1.55 to 9.22)) and cerebrovascular events (adjusted OR 2.67 (95% CI 1.52 to 6.03)). Kaplan–Meier survival analysis showed a twelve-month survival rate of 82.1% in sarcopenic patients, which was significantly lower than the non-sarcopenic group (p = 0.034). Finally, both ASM and low muscle strength were independently related to increased mortality risk in dialysis patients (OR 1.86; 95% CI 1.31 to 2.62 and OR 2.31 95% CI 1.49 to 3.93, respectively). Conclusion Our study demonstrated that sarcopenia was highly prevalent among HD patients and was shown to be a significant predictor of poor patients outcomes. Future research should address whether the early diagnosis and treatment of sarcopenia improve outcomes.

Persistence of antibody to 23-valent pneumococcal polysaccharide vaccine: a 5-year prospective follow-up cohort study

ABSTRACT Background Pneumococcal vaccines are effective in preventing pneumococcal diseases in adults. The evaluation of the antibodies persistence to the 23-valent pneumococcal polysaccharide vaccine (PPV23) could provide evidence on PPV23 revaccination. Research design and methods Adults aged ≥ 60 years were selected and vaccinated with PPV23 in Shanghai, and followed up for 5 years with blood samples collection of a 1-year interval. The geometric mean concentrations (GMC) of the IgG against 23 pneumococcal serotypes covered by PPV23 were detected using enzyme-linked immunosorbent assay. The antibodies to 23 pneumococcal serotypes among different groups was analyzed using statistical analysis. Results Overall, 517 participants completed all six visits over a 5-year period (2013–2018). The GMC of 23 serotypes in adults aged ≥ 60 years decreased slowly after PPV23 vaccination compared to baseline pre-vaccination (P < 0.05), except serotype 3. Additionally, the multiplicative increase in the antibody concentration after PPV23 vaccination was greater, and the antibody levels of serotypes 1 and 6B were significantly higher at visit 5 than at visit 4 (P < 0.05). Conclusions The pneumococcal antibodies in elderly after PPV23 vaccination could sustain high levels over long-term follow-up, which suggested that the interval of revaccination with PPV23 in elderly should be at least 5 years after the first vaccination.

Full Arch Implant-Prosthetic Rehabilitation in Patients with Cardiovascular Diseases: A 7-Year Follow-Up Prospective Single Cohort Study.

Aim: The rising average age increases edentulous cases, demanding more implant-prosthetic rehabilitation, with cardiovascular diseases being significant factors. This study compared healthy patients (CG = Control Group) and those with cardiovascular disease (TG = Test Group) for implant survival, Marginal Bone Loss (MBL), peri-implant tissue level parameters as Periodontal Screening and Recording (PSR), Plaque Index (PI), Bleeding on Probing (BoP) Peri-implant Probing Depth (PPD), and surgical complications. Smoking impact on both groups and medication influence in the TG were secondary outcomes. Patients underwent full-arch implant prosthetic rehabilitation. Methods: Implant survival rate, MBL, and surgical complications were recorded during the monitoring period (7 years), while peri-implant parameters were assessed at the end of the observational time. A total of 26 and 28 CG and TG patients were recruited, respectively. Results: A total of 128 implants were placed in CG, while 142 in the TG. Implant survival and MBL showed no significant differences (p > 0.05). Nevertheless, peri-implant parameters were more unfavorable in TG. The only significant surgical complication was higher bleeding rates in the TG (p < 0.05). Conclusions: Cardiovascular patients showed similar implant survival and MBL but had adverse peri-implant parameters and increased bleeding rates. Higher smoking levels may relate to unfavorable implant outcomes. Further investigation is needed on drug impact with larger samples.

Protocol for a multicentre and prospective follow-up cohort study of early detection of atrial fibrillation, silent stroke and cognitive impairment in high-risk primary care patients: the PREFA-TE study

BackgroundAtrial fibrillation (AF) is the most common type of cardiac arrhythmia. Future estimations suggest an increase in global burden of AF greater than 60% by 2050. Numerous studies provide growing...

Impaired kidney function and the risk of all-cause mortality and cardiovascular disease among Chinese hypertensive adults: Using three different equations to estimate the glomerular filtration rate

ObjectivesWe aimed to seek accurate assessments of the glomerular filtration rate (GFR) in a Chinese hypertensive population to identify individuals at high risk for chronic kidney disease (CKD) progression. Then, the risk of cardiovascular disease (CVD) and all-cause death due to kidney injury were further investigated under appropriate GFR-estimation equations. MethodsIn this prospective follow-up cohort study of 10,171 hypertensive patients, we compared the discrimination power of a trio of GFR-estimation equations using Harrell's C-index, measuring the model fit by calculating the Akaike information criterion. Univariate and multivariable logistic regression analyses were respectively used to calculate the hazard ratio (HR) and 95% confidence interval [CI] values for CKD progression. In addition, we also assessed the risk of CVD and all-cause death with impaired renal function using multivariable-adjusted Cox regression models. ResultsThe Modification of Diet in Renal Disease (MDRD) equation showed the highest C-index range for the predicted probability of CKD progression in the fully adjusted model. During MDRD analysis, a low eGFR (60–89 mL/min/1.73m2 or < 60 mL/min/1.73m2) was an independent risk factor for CVD, especially stroke (1.28 [95% CI, 1.05–1.55] and 1.89 [95% CI, 1.08–3.31]), as well as all-cause mortality (1.28 [95% CI, 1.09–1.50] and 1.68 [95% CI, 1.01–2.78]). ConclusionsThe MDRD equation seems to be more suitable for screening CKD progression in Chinese hypertensive populations, targeting potential risk factors for effective prevention to reduce renal impairment so as to further limit CVD morbidity and mortality.

Functional Outcome of Subvastus versus Medial Parapatellar Approaches for Total Knee Replacement in Patients with Knee Osteoarthritis: A Prospective Cohort Study.

Subvastus approach and medial parapatellar approach are two major approaches for total knee replacement (TKR). There is no global consensus on the superiority of either approach in terms of functional outcomes. The present study aimed to evaluate the functional outcome of TKR through subvastus approach and medial parapatellar approach by using patient-reported scores at 3-, 6-, and 12-month post-operative follow-ups. This prospective cohort follow-up study included patients with knee osteoarthritis who underwent elective primary TKR either through the subvastus or medial parapatellar approaches at King Abdullah Medical City, Makkah city, Kingdom of Saudi Arabia, from January 2019 to December 2022. Scores from the self-reported Oxford Knee Score (OKS) and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) were compared in the two groups of patients at 3-, 6-, and 12-month post-operative follow-ups. A total of 98 patients were included, of which 37 underwent TKR through the subvastus approach and 61 through the medial parapatellar approach. There was an overall significant change over time in both WOMAC and OKS scores (P < 0.001). Patients who underwent the subvastus approach had significantly higher mean of WOMAC and OKS than patients with the medial parapatellar approach at the 3- and 6-month follow-ups (P < 0.05), but not at the 12-month follow-up. For TKR, the medial parapatellar approach results in better functional outcomes at the 3- and 6- month follow-up periods compared with the subvastus approach.

Dynamic Monitoring of Intracellular Tacrolimus and Mycophenolic Acid Therapy in Renal Transplant Recipients Using Magnetic Bead Extraction Combined with LC-MS/MS.

Tacrolimus (TAC) and mycophenolic acid (MPA) are commonly used immunosuppressive therapies after renal transplant. Our objective was to quantify TAC and MPA concentrations in peripheral blood mononuclear cells (PBMCs) using liquid chromatography tandem mass spectrometry (LC-MS/MS) and to evaluate and validate the performance of the methodology. A prospective follow-up cohort study was conducted to determine whether intracellular concentrations were associated with adverse outcomes in renal transplants. PBMCs were prepared using the Ficoll separation technique and purified with erythrocyte lysis. The cells were counted using Sysmex XN-3100 and then packaged and frozen according to a 50 µL volume containing 1.0 × 106 cells. TAC and MPA were extracted using MagnaBeads and quantified using an LC-MS/MS platform. The chromatography was run on a reversed-phase Waters Acquity UPLC BEH C18 column (1.7 µm, 50 mm × 2.1 mm) for gradient elution separation with a total run time of 4.5 min and a flow rate of 0.3 mL/min. Mobile phases A and B were water and methanol, respectively, each containing 2 mM ammonium acetate and 0.1% formic acid. Renal transplant recipients receiving TAC and MPA in combination were selected for clinical validation and divided into two groups: a stable group and an adverse outcome group. The concentrations were dynamically monitored at 5, 7, 14, and 21 days (D5, D7, D14, and D21) and 1, 2, 3, and 6 months (M1, M2, M3, and M6) after operation. Method performance validation was performed according to Food and Drug Administration guidelines, showing high specificity and sensitivity. The TAC and MPA calibration curves were linear (r2 = 0.9988 and r2 = 0.9990, respectively). Both intra-day and inter-day imprecision and inaccuracy were less than 15%. Matrix effects and recoveries were satisfactory. The TAC and MPA concentrations in 304 "real" PBMC samples from 47 renal transplant recipients were within the calibration curve range (0.12 to 16.40 ng/mL and 0.20 to 4.72 ng/mL, respectively). There was a weak correlation between PBMC-C0TAC and WB-C0TAC (p < 0.05), but no correlation was found for MPA. The level of immunosuppressive intra-patient variation (IPV) was higher in PBMC at 77.47% (55.06, 97.76%) than in WB at 34.61% (21.90, 49.85%). During the dynamic change in C0TAC, PBMC-C0TAC was in a fluctuating state, and no stable period was found. PBMC-C0TAC did not show a significant difference between the stable and adverse outcome group, but the level of the adverse outcome group was generally higher than that of the stable group. Compared with conventional therapeutic drug monitoring, the proposed rapid and sensitive method can provide more clinically reliable information on drug concentration at an active site, which has the potential to be applied to the clinical monitoring of intracellular immunosuppressive concentration in organ transplantation. However, the application of PBMC-C0TAC in adverse outcomes of renal transplant should be studied further.

Comparison of risk factors for hemorrhagic stroke and ischemic stroke, a prospective long-term follow-up cohort study

Objective: To analyze and compare the risk factors for hemorrhagic stroke and ischemic stroke and understand the exposure levels in population. Methods: A cohort study of risk factors of stroke was conducted in a rural community in Fengxian District of Shanghai in 2003, and the common risk factors of stroke were investigated at baseline survey, the cerebrovascular hemodynamics indexes were detected, the cerebrovascular function score was calculated according to the unified integral rule, and the incidence of stroke was observed in follow up. The risk factors for hemorrhagic stroke and ischemic stroke were analyzed by cohort study. The risk factors for two subtypes of stroke were compared. Result: A total of 10 565 participants were included in the study, with a mean follow-up period of (11.15±2.26) years, and 103 hemorrhagic stroke cases and 268 ischemic stroke cases were observed during follow-up period. The independent risk factors of hemorrhagic stroke included decreased cerebrovascular function score [hazard ratio (HR)=1.56, 95%CI: 1.23-1.98], history of alcohol consumption (HR=2.46, 95%CI: 1.39-4.34), hypertension (HR=1.75, 95%CI: 1.00-3.07) and older age (HR=1.07, 95%CI: 1.04-1.10). The independent risk factors of ischemic stroke included decreased cerebrovascular function score (HR=1.43, 95%CI: 1.25-1.65), smoking history (HR=1.52, 95%CI: 1.13-2.05), hypertension (HR=1.51, 95%CI: 1.10-2.07), family history of stroke (HR=1.89, 95%CI: 1.13-3.15), left ventricular hypertrophy (HR=1.74, 95%CI: 1.07-2.81) and older age (HR=1.07, 95%CI: 1.05-1.08). Conclusions: Decreased cerebrovascular function score, hypertension, and older age were common independent risk factors of both types of stroke, alcohol consumption history was an independent risk factor of hemorrhagic stroke, and smoking history, and family history of stroke and left ventricular hypertrophy were independent risk factors of ischemic stroke.

Implementation of the International Classification of Functioning, Disability and Health model in cochlear implant recipients: a multi-center prospective follow-up cohort study

IntroductionNo standard protocol based on a multidisciplinary framework currently exists for the evaluation, follow-up and interpretation of Cochlear Implant (CI) outcomes in clinical routine. Therefore, this study aimed to develop and clinically implement a multidimensional Cochlear Implant (CI) outcome assessment protocol for adult CI users based on the International Classification of Functioning, Disability and Health (ICF).MethodsAn international multidisciplinary core group of CI experts selected the most relevant ICF categories and codes for adult CI users out of the existing ICF core set for hearing loss. A well-known, commonly used instrument or method was identified and assigned to each ICF category along with quantified ICF qualifiers. These qualifiers facilitate the interpretation of CI outcomes by categorizing the outcome on a rating scale between 0 and 4, based on the severity of participants' impairment/restriction/limitation/barrier. The ICF-based CI outcome assessment protocol was applied in clinical routine in a prospective longitudinal multicenter study assessing a consecutive sample of 72 adult CI candidates before and 6 months after implantation. For each relevant ICF category, the participants' improvement, stability or deterioration was specified in a descriptive approach using ICF qualifiers.ResultsParticipants either showed improved or stable ICF qualifiers after cochlear implantation across all ICF domains (e.g., Body Functions and Structures, Activities, and Participation and Environmental factors). The ICF qualifiers for environmental sound tolerance (n = 30 [45%]) and vestibular functions (n = 21 [33%]) deteriorated most frequently after implantation. ICF qualifiers for falling (n = 53 [83%]) and dizziness (n = 40 [62%]) remained stable in most participants. Auditory perception-related and communication-related categories generally improved in most participants after cochlear implantation, with 46 to 73% (n = 34 to n = 48) of CI users perceiving an improvement postoperatively.ConclusionThis study is the first to propose and apply a ready-to-use CI outcome assessment protocol based on the ICF model, which provides a common language and comprehensive assessment protocol for the description and measurement of CI outcomes worldwide. Its straightforward outcome description and rating enables CI outcome interpretation by non-experts, enhancing multidisciplinary communication and knowledge on individual healthcare needs in CI users.

Extra-musculoskeletal manifestations driving the therapeutic decision-making in patients with Spondyloarthritis: a 12-month follow-up prospective cohort study

BackgroundThe extra-musculoskeletal manifestations (EMMs) such as recurrent acute anterior uveitis (rAAU), psoriasis (Ps), and inflammatory bowel disease (IBD), are related to the Spondyloarthritis (SpA), as well as they are associated with disease activity and poor prognosis. However, there are no data addressing its relevance regarding therapeutic decision-making in clinical practice.ObjectiveTo evaluate the impact of EMMs to drive the treatment decision-making in patients with SpA in a 12-month follow-up.Patients and methodsSpA patients, according to the axial and peripheral ASAS classification criteria, as well as CASPAR criteria, with any active EMM, defined as main entry criteria, were included in this longitudinal cohort study. Individuals with a history of any disease or condition that could be associated with some of the studied endpoints, including neoplasms and infectious diseases, were excluded. Specific tools related to each EMM, including Psoriasis Area Severity Index (PASI), ophthalmologic evaluation, according to the Standardization of Uveitis Nomenclature (SUN) criteria, and gut complaints were used at baseline and during the 3-, 6- and 12-month of follow-up as outcomes measures over time. Descriptive and inferential analyses were used appropriately, including Pearson’s correlation test, chi-squared test, and ANOVA. P value less than 0.05 was considered as significant.ResultsA total of 560 patients were enrolled, of whom 472 meet the eligibility criteria. The majority (N = 274; 59.6%) had one or more EMM related to SpA umbrella concept. Among the EMM, the one that most influenced therapeutic decision-making was psoriasis (28.5%), followed by uveitis (17.5%) and IBD (5.5%), regardless of musculoskeletal manifestations. Clinical improvement of EMMs outcomes was observed in most patients over 12-month follow-up, especially in those with rAAU and IBD (P < 0.001).ConclusionOur results showed that EMMs guided the therapeutic decision-making in half of SpA patients, regardless of musculoskeletal condition, suggesting the inter-disciplinarity among the rheumatologist, ophthalmologist, dermatologist, and gastroenterologist plays a crucial role to manage them.

Association of periodontitis with cognitive decline and its progression: Contribution of blood-based biomarkers of Alzheimer's disease to this relationship.

To assess whether periodontitis is associated with cognitive decline and its progression as well as with certain blood-based markers of Alzheimer's disease. Data from a 2-year follow-up prospective cohort study (n = 101) was analysed. Participants with a previous history of hypertension and aged ≥60 years were included in the analysis. All of them received a full-mouth periodontal examination and cognitive function assessments (Addenbrooke's Cognitive Examination (ACE) and Mini-Mental State Examination [MMSE]). Plasma levels of amyloid beta (Aβ)1-40 , Aβ1-42 , phosphorylated and total Tau (p-Tau and t-Tau) were determined at baseline, 12 and 24 months. Periodontitis was associated with poor cognitive performance (MMSE: β = -1.5 [0.6]) and progression of cognitive impairment (hazard ratio [HR] = 1.8; 95% confidence interval: 1.0-3.1). Subjects with periodontitis showed greater baseline levels of p-Tau (1.6 [0.7] vs. 1.2 [0.2] pg/mL, p < .001) and Aβ1-40 (242.1 [77.3] vs. 208.2 [73.8] pg/mL, p = .036) compared with those without periodontitis. Concentrations of the latter protein also increased over time only in the periodontitis group (p = .005). Periodontitis is associated with cognitive decline and its progression in elderly patients with a previous history of hypertension. Overexpression of p-Tau and Aβ1-40 may play a role in this association.

Lung function, respiratory symptoms and incident venous thromboembolism during a 44-year follow-up

BackgroundChronic obstructive pulmonary disease (COPD) and infections are risk factors for venous thromboembolism (VTE), but the reasons behind the associations are not fully known. Few studies have investigated whether lung function and respiratory symptoms in individuals without COPD are associated with VTE. ObjectivesTo study the incidence of VTE in individuals without COPD and other major VTE risk factors, in relation to baseline lung function and respiratory symptoms, through a 44-year follow-up prospective cohort study. MethodsAs part of a health screening program, a total of 20,253 men and 7361 women underwent a baseline examination from 1974 to 1992, including a spirometry test and a self-administered questionnaire about respiratory symptoms, e.g., chronic bronchitis, cough, phlegm, and dyspnoea. Lung function was assessed through quartiles of forced expiratory volume in 1 s/forced vital capacity (FEV1/FVC). Through linkage with national registers, all individuals were followed for incidence of VTE. ResultsRespiratory symptoms (cough and dyspnoea) at baseline were associated with an increased risk of incident VTE in women after adjustments for age, height, BMI, smoking status, varicose veins, and FEV1/FVC. The adjusted hazard ratio in relation to chronic bronchitis was 1.57 (95% confidence interval 1.17–2.11). Poor lung function was not associated with an increased risk of VTE after adjustments for potential confounders. ConclusionWomen with respiratory symptoms of cough and dyspnoea without COPD have an increased risk of VTE, independent of lung function and major VTE risk factors. Further studies are needed to confirm the association and to study the clinical applicability of the results.

Post-infection functional gastrointestinal disorders following coronavirus disease-19: a prospective follow-up cohort study

BackgroundAcute gastrointestinal infections can lead to post-infectious irritable bowel syndrome (PI-IBS). Moreover, coronavirus disease (COVID-19) is related to long-term gastrointestinal sequelae. In this study, the frequency, disease spectrum, and risk factors for post-infection functional gastrointestinal disease (PI-FGID) in COVID-19 patients and healthy controls were prospectively examined.MethodsValidated Rome III and Rome IV questionnaires and limited objective assessment were used to assess the incidence of PI-FGID in 190 COVID-19 patients, and 160 healthy controls prospectively followed for 1, 3, and 6 months.ResultsSix(3.2%), 1(0.5%), 3(1.6%), 5(2.6%), 6(3.2%)COVID-19 patients had diarrhea, abdominal pain, constipation, dyspepsia and their overlap at 1 month, respectively, while 4(2.1%), 1(0.5%), 4(2.1%), 4(2.1%), and 6(3.2%)COVID-19 patients had diarrhea, abdominal pain, constipation, dyspepsia and their overlap at three months, respectively. Furthermore, 2(1.3%), 4(2.5%), and 3(1.9%)healthy controls developed constipation, dyspepsia, and their overlap at one month, respectively (P = 0.193), while 2(1.3%), 4(2.5%), and 2(1.3%)healthy controls developed constipation, dyspepsia and their overlap at three months, respectively (P = 0.286). FGIDs incidence was higher among COVID-19 patients(8.9%) than in healthy controls(3.1%) at 6-month follow-up (P = 0.025). Moreover, 7 (3.7%), 5 (2.6%), 3 (1.6%), and 2 (1.1%) COVID-19 patients developed IBS, functional dyspepsia(FD), functional diarrhea(FDr), functional constipation(FC)at six months, respectively, while only 2 (1.3%) and 3 (1.9%) healthy controls developed IBS and FD at six months, respectively. Notably, gastrointestinal(GI)symptoms at onset were the independent risk factors for post-COVID-19 FGIDs at six months.ConclusionsCOVID-19 increases new-onset PI-FGID at six months compared with healthy controls. GI symptom at the onset of COVID-19 is an independent risk factor for post-COVID-19 FGIDs.

Moderate-to-high risk of obstructive sleep apnea with excessive daytime sleepiness is associated with postoperative neurocognitive disorders: a prospective one-year follow-up cohort study.

Few studies found that obstructive sleep apnea (OSA) may be related to postoperative neurocognitive disorders (PND) including postoperative delirium (POD) and cognitive decline (POCD) in the early postoperative period. However, the results are controversial and need further verification, and no research has explored the effect of OSA on the incidence of PND during the 1-year follow-up periods. Furthermore, OSA patients with excessive daytime sleepiness (EDS) as a severe phenotype have more significant neurocognitive impairments, but the relationship between OSA with EDS and PND within 1 year after surgery has not been studied. To explore the effect of moderate-to-high risk of OSA and the moderate-to-high risk of OSA with EDS on PND within 1 year after surgery. In this prospective cohort study, including 227 older patients, moderate-to-high risk of OSA (using STOP-BANG), subjective EDS (using Epworth Sleepiness Scale), and objective EDS (using Actigraphy) were selected as exposures. Key outcomes included POD during hospitalization (using Confusion Assessment Method-Severity), POCD at discharge, 1-month and 1-year after surgery (using Mini-Mental State Examination and Telephone Interview for Cognitive Status-40). We applied multiple logistic regression models to estimate the effect of moderate-to-high risk of OSA and moderate-to-high risk of OSA with EDS on PND. In the multivariate analysis, moderate-to-high risk of OSA was not associated with POD during hospitalization and POCD at discharge, 1-month, and 1-year after surgery (p > 0.05). However, the moderate-to-high risk of OSA with subjective EDS was related to POCD at discharge compared to the moderate-to-high risk of OSA or normal group (no moderate-to-high risk of OSA and no EDS) (p < 0.05). In addition, moderate-to-high risk of OSA with objective EDS was associated with POCD at discharge, 1-month, and 1-year postoperatively compared to the moderate-to-high risk of OSA or normal group (p < 0.05). Moderate-to-high risk of OSA with EDS, not moderate-to-high risk of OSA alone, was a clinically helpful predictor for POCD within 1-year after surgery and should be routinely assessed before surgery.