Prospective Cohort Research Articles

Clinical features and progression of Parkinson's disease with LRRK2 variants: A prospective study.

We established a prospective cohort study to investigate the differences in motor and non-motor symptoms between idiopathic Parkinson's disease (IPD) and Parkinson's disease in carriers of leucine-rich repeat kinase 2 (LRRK2) gene risk variants (LRRK2-PD). The study included 1407 individuals with IPD and 649 individuals with LRRK2-PD (comprising 304 with LRRK2-G2385R, 220 with LRRK2-R1628P, and 105 with LRRK2-A419V). Differences in symptoms between LRRK2-PD and IPD were analyzed using LCMM modeling and Cox regression analysis. The LRRK2-G2385R variant showed slower progression in tremor symptoms and excessive daytime sleepiness compared with IPD. In contrast, symptoms associated with LRRK2-R1628P and LRRK2-A419V were more similar to those of IPD. Survival analysis revealed that LRRK2-PD does not affect life expectancy compared with IPD. Our extended longitudinal follow-up of LRRK2-PD in the Chinese population provided valuable insights, further confirming the clinical characteristics of the three LRRK2 variants.

Clinical outcomes following acute sore throat assessment at community pharmacy versus general practice: a retrospective, longitudinal, data linkage study.

To date, no research has compared longer-term outcomes (antibiotic provision; re-consultations; hospital admissions for quinsy; cost-effectiveness) following presentation with acute sore throat at general practice (GP) versus newer, pharmacy-led services. A retrospective, longitudinal cohort study of sore throat consultations between 1 November 2018 and 28 February 2020 either with the Wales pharmacy-led sore throat test and treat (STTT) service or with a healthcare professional at GP. Individual-level pharmacy consultation data from the national Choose Pharmacy IT application were securely uploaded to the Secure Anonymised Information Linkage Databank and linked to routinely collected, anonymized, population-scale, individual-level, anonymized health and administrative data. Of 72 736 index consultations, 6495 (8.9%) were with STTT and 66 241 (91.1%) with GP. Antibiotic provision at the index consultation was 1382 (21%) with STTT and 25 506 (39%) with GP [adjusted odds ratio (AOR), 0.30; 95% CI, 0.27 to 0.32]. Antibiotic provision within 28 days of index occurred in 1820 (28%) STTT and 26 369 (40%) GP consultations (AOR, 0.44; 95% CI, 0.41 to 0.47). GP re-consultation rate within 28 days of index date was 21% (n = 1389) with STTT compared with 7.4% (n = 4916) with GP (AOR, 3.8; 95% CI, 3.5 to 4.1). Coding limitations may lead to overestimates of GP re-consultations rates in the STTT group. Hospital admissions for quinsy were rare in both STTT (n = 20, 0.31%) and GP (n = 274, 0.41%) (AOR, 0.68; 95% CI, 0.43 to 1.1). STTT was less costly than consultation with GP. The pharmacy-led STTT service is safe, cost-effective, and contributes to antimicrobial stewardship.

EPID-06. ACROMEGALY AND THE RISK OF CANCER: A NATIONWIDE POPULATION-BASED LONGITUDINAL COHORT STUDY IN KOREARUNNING TITLE: ACROMEGALY AND THE RISK OF CANCER

Abstract INTRODUCTION Previous reports on cancer risk in patients with acromegaly have inconsistent findings. Using a nationwide population-based cohort, we primarily investigated whether overall and site-specific cancer risk are increased in patients with acromegaly. MATERIALS AND METHODS The study included 2,382 acromegaly patients and 11,910 controls aged above 20, from 2006 to 2016. Cox hazards regression analysis was used, adjusting for baseline covariates. RESULTS Among the 2,382 patients with acromegaly, overall cancer occurred in 244 (10.2%), while the 11,910 controls had 707 (5.9%) occurrences (HR: 1.90 (95% CI: 1.63-2.22). Acromegaly patients had the highest relative risk for brain cancers with an HR of 6.80 (95% CI: 2.83-16.38) and significantly higher risk of lymphoma, thyroid cancer, multiple myeloma, pancreatic cancer, and colorectal cancer. Even after five years from the diagnosis of acromegaly, patients with acromegaly had a significantly higher incidence of cancer. Risk of cancer in general and stomach cancer in specific was significantly higher in patients under the age of 50 compared to older patients. There was no sex difference. CONCLUSIONS This nationwide longitudinal cohort study shows an increased risk of cancer in acromegaly patients. Active and long-term cancer screening is necessary to improve the prognosis in patients with acromegaly.

NIMG-81. PREDICTING TUMOR PROGRESSION WITH FIBER DENSITY-WEIGHTED WHITE MATTER PATHLENGTH MAPS IN PATIENTS WITH GLIOBLASTOMA

Abstract PURPOSE Although histopathological evidence indicates that glioma cells preferentially migrate along large white-matter bundles, standard-of-care (SOC) radiation therapy (RT) planning remains an isotropic expansion of the anatomical lesion. We hypothesize that anisotropic expansion of RT target volumes along white-matter pathways using fiber density-weighted, white-matter pathlength maps (DW-WMPLMs) derived from diffusion tensor imaging (DTI) could improve the prediction of tumor cell migration beyond surgical margins by a deep learning model compared to SOC clinical target volumes (CTVs). METHODS DTI and anatomical MRI from 118 patients newly-diagnosed with glioblastoma were retrospectively analyzed with anatomical imaging from post-surgical resection and latest progression scan before intervention. Parallel-transport tractography seeded from the pre-surgery T2-lesion was used to estimate white-matter fiber propagation. Fibers that intersected with the resection cavity were weighted by their density to control the length of expansion and create a DW-WMPLM that was used together with T2-FLAIR and T1-post-contrast images as inputs to a novel 3D-Swin-UNetR network, trained to predict the recurrence region using 4-fold cross-validation and evaluated in a holdout test-set (95/23 CV/test). New weighted-overlap, coverage, and sparing indices were introduced to evaluate coverage of the progressed lesion and healthy brain excluded. RESULTS 52% of patients had progression outside the standard 2cm-isotropic CTV margin, motivating the need for anisotropic CTVs. Our novel DW-WMPLMs had 87±20% and 83±18% overlap with contrast-enhancing and T2-lesion progression, respectively. The deep-learning model trained with DW-WMPLMs and anatomical images achieved 19% and 56% higher Dice and weighted-overlap indices compared to the isotropic 2cm-CTV(p<0.02), with less normal brain included. CONCLUSION This study demonstrates the feasibility and benefit of incorporating a novel metric of white-matter track characterization into deep learning progression prediction models of glioblastoma for RT-planning. Current work is validating findings in a prospective cohort acquired immediately prior to RT and incorporating other imaging metrics.

Associations of Circulating Platelet Endothelial Cell Adhesion Molecule-1 Levels With Progression of Cerebral Small-Vessel Disease, Cognitive Decline, and Incident Dementia.

The association between platelet endothelial cell adhesion molecule-1 (PECAM-1) with cerebral small-vessel disease and cognition in dementia-free subjects remains uninvestigated. A prospective cohort of dementia-free subjects was recruited from memory clinics and followed up for 5 years. Annual neurocognitive assessments and twice-yearly brain magnetic resonance imaging scans were performed. Associations of baseline plasma PECAM-1 levels with cerebral small-vessel disease, cognitive decline (Montreal Cognitive Assessment scores and executive function Z scores), and incident dementia were evaluated. Of 213 subjects (aged 70.2±7.7 years, 51.2% men), median PECAM-1 levels were 0.790 (interquartile range, 0.645-0.955 ng/mL). Compared with the highest tertile, subjects within the lowest PECAM-1 tertile had greater cross-sectional white matter hyperintensity volume (β=4.84 [95% CI, 0.67-9.01]; P=0.023), age-related white matter change scores (β=1.39 [95% CI, 0.12-2.67]; P=0.033), and cerebral microbleeds (Adjusted risk ratio, 2.59 [95% CI, 1.19-5.62]; P=0.016). Of the 204 participants with follow-up data (median, 60.0 [interquartile range, 60.0-60.0] months), 24 (11.8%) developed incident dementia. Compared with the highest tertile, subjects within the lower tertiles of PECAM-1 had a higher risk of incident dementia (first tertile: adjusted hazard ratio [AHR], 4.52 [95% CI, 1.35-15.13]; P=0.024; second tertile: AHR, 3.28 [95% CI, 1.02-10.60]; P=0.047). The lowest PECAM-1 tertile was associated with greater progression of white matter hyperintensity volume (β=4.15 [95% CI, 0.06-8.24]; P=0.047), cerebral microbleeds (incident relative risk [IRR], 2.21 [95% CI, 1.05-4.65]; P=0.036), and decline in executive function (β=-0.45 [95% CI, -0.76 to -0.14]; P=0.004), and Montreal Cognitive Assessment (β=-1.32 [95% CI, -2.30 to -0.35]; P=0.008) scores. In dementia-free subjects, lower circulating PECAM-1 levels are associated with greater cerebral small-vessel disease progression and cognitive decline, thus warranting future study as a potential therapeutic target.

INNV-06. ADULT GLIOBLASTOMA WITH MISMATCH REPAIR DEFICIENCY FORMS A DISTINCT HIGH-RISK MOLECULAR SUBGROUP FOR WHICH TREATMENT WITH IPILIMUMAB-NIVOLUMAB SHOWS SURVIVAL ADVANTAGE

Abstract Glioblastoma is the most frequent and malignant primary brain tumor. Although the survival is generally dismal for glioblastoma patients, risk stratification and the identification of high-risk subgroups is important for prompt and aggressive management. The G1-G7 molecular subgroup classification based on the MAPK pathway activation has offered for the first time a non-redundant, all-inclusive classification of adult glioblastoma. Five patients from the large, 220-patient prospective cohort showed germline mutations in mismatch repair (MMR) genes and significantly worse median survival (3.25 months post-surgery) than those from other subgroups or from the rest of the cohort adjusted for age. These tumors were assigned to a new subgroup, G3/MMR, a spin-off from the major G3/NF1 subgroup, as they generally show genomic alterations leading to RAS activation. An integrated clinical, histological, immunohistochemical and molecular analysis of the G3/MMR tumors showed distinct characteristics as compared to other glioblastomas, including those with iatrogenic high tumor mutation burden (TMB), warranting a separate subgroup. Among these, prior history of cancer, midline location or multifocality, presence of multinucleated giant cells, positive p53 and MMR immunohistochemistry, and specific molecular characteristics, including high TMB, alert to this high-risk G3/MMR subgroup. High TMB constitutes the criterium for treatment with immune checkpoint inhibitors in solid cancers. The FDA-approved first-line therapy for advanced non-small cell lung cancer and high-TMB colorectal cancer is with the dual ipilimumab-nivolumab regimen. One of the five G3/MMR subgroup patients received the dual ipilimumab-nivolumab regimen and survived much longer than the rest of the G3/MMR patients, setting a proof-of-principle example for the treatment of these very aggressive G3/MMR glioblastomas.

Validation of a urine- based proteomics test to predict clinically significant prostate cancer: complementing mpMRI pathway.

INTRODUCTIONː Prostate cancer (PCa) is the most frequently diagnosed cancer among men. A major clinical need is to accurately predict clinically significant PCa (csPCa). A proteomics-based 19-biomarker model (19-BM) was previously developed using capillary electrophoresis-mass spectrometry (CE-MS) and validated in 1000 patients at risk for PCa. This study aimed to validate 19-BM in a multicenter prospective cohort of 101 biopsy-naive patients using current diagnostic pathways. METHODSː Urine samples from 101 patients with PCa were analyzed using CE-MS. All patients underwent MRI using a 3-T system. The 19-BM score was estimated using support vector machine-based software (MosaCluster v1.7.0), employing a previously established cut-off criterion of -0.07. Previously developed diagnostic nomograms were calculated along with MRI. RESULTSː Independent validation of 19-BM yielded a sensitivity of 77% and a specificity of 85% (AUC:0.81). This performance surpassed those of PSA (AUC:0.56) and PSA density (AUC:0.69). For PI-RADS≤ 3 patients, 19-BM showed a sensitivity of 86% and a specificity of 88%. Integrating 19-BM with MRI resulted in significantly better accuracy (AUC:0.90) compared to individual investigations alone (AUC19BM=0.81; p=0.004 and AUCMRI:0.79; p=0.001). Examining the decision curve analysis, 19-BM with MRI surpassed other approaches for the prevailing risk interval from a 30% cut-off. CONCLUSIONSː 19-BM exhibited favorable reproducibility for the prediction of csPCa. In patients with PI-RADS≤3, 19-BM correctly classified 88% of the patients with insignificant PCa at the cost of one missed csPCa patient. Utilizing the 19-BM test could prove valuable in complementing MRI and reducing the need for unnecessary biopsies.

Clinical Characteristics and Outcomes of Cardiac Findings in Young Persons Following SARS-CoV-2 Infection

We studied cardiac complications in young persons with severe acute respiratory syndrome coronavirus 2. In a prospective cohort of 127 Military Health System beneficiaries 0–22 years old, 3.1% had cardiac abnormalities, all resolved within 6 months. Our findings support guidelines against routine cardiac screening in mild COVID-19 cases without cardiac symptoms.

Usage of table salt and risk of all-cause and cardiovascular disease mortality among patients with diabetes: a national population-based cohort study

BackgroundA lower dietary sodium intake has been associated with a reduced risk of cardiovascular disease (CVD) mortality in the general population. However, the evidence is less clear in diabetic patients. The study aims to investigate whether the usage of table salt is associated with all-cause and CVD mortality among individuals with diabetes.MethodsIn this prospective cohort study, participants with diabetes from the U.S. National Health and Nutritional Examination Survey (NHANES) 2003–2018 were included. Weighted linear regression models were employed to assess the association between the usage of table salt and dietary sodium intake. Weighted Cox proportional hazards regression models were used to assess the association between the usage of table salt and all-cause and CVD mortality.ResultsThis cohort study included data from 6,258 participants in analysis. During 44,035 person-years of follow-up, 1,504 deaths from all-causes and 427 from CVD were documented. Not using table salt was significantly associated with lower dietary sodium intake, with a β of -192.60 (95% CI, -297.01 to -88.18) mg. A higher risk of all-cause and CVD mortality was observed in the group of participants not using table salt among patients with diabetes. Compared with participants using table salt, the hazard ratios for all-cause mortality were 1.18 (95% CI, 1.03 to 1.35), and for CVD were 1.48 (95 CI, 1.16 to 1.90) for participants not using table salt. The subgroup analysis revealed a significantly stronger link between the usage of table salt and all-cause mortality in participants with CVD (P for interaction = 0.004).ConclusionsThis study indicated that not using table salt was associated with a lower dietary sodium intake, and an increased risk of all-cause and CVD mortality among individuals with diabetes. Interventional studies are needed to determine more beneficial relevant approaches to dietary management in diabetes care.

CYP3A4*1B and CYP3A5*3 SNPs significantly impact the response of Egyptian candidates to high-intensity statin therapy to atorvastatin

BackgroundA single nucleotide polymorphism (SNP) is a variation in the DNA sequence that results from the alteration of a single nucleotide in the genome. Atorvastatin is used to treat hypercholesterolemia. It belongs to a class of drugs called statins, which lower elevated levels of total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C). Research findings on the associations between the response to atorvastatin and genetic polymorphisms in CYP3A4 and CYP3A5 are inconclusive. The effects of CYP3A4*1B (rs2740574 C/T) and CYP3A5*3 (rs776746 T/C) on atorvastatin therapy have not been previously studied among Egyptians.ObjectiveThis research aimed to investigate the effects of the genetic polymorphisms CYP3A4*1B and CYP3A5*3 on atorvastatin treatment in Egyptians.MethodsIn this prospective cohort study, 100 subjects were genotyped for these SNPs. All participants were screened for serum lipid profiles, liver enzymes, total bilirubin (TB), and creatine kinase (CK) before and after 40 mg postatorvastatin therapy. Atorvastatin plasma levels were assessed posttreatment; atorvastatin pharmacokinetics were evaluated in five carriers of the CYP3A4*1B (T/T) and CYP3A5*3 (C/C) genotypes.ResultsThe allele frequencies of the CYP3A4*1B and CYP3A5*3 SNPs were 86% and 83%, respectively. The CYP3A4*1B (T/T) and CYP3A5*3 (C/C) genotypes significantly improved the serum triglyceride (TG) level (P < 0.05) and elevated the TB level (P < 0.001). Atorvastatin plasma levels were greater in CYP3A4*1B (T/T) (P < 0.05) and CYP3A5*3 (C/C) (P < 0.001) genotype carriers. Both SNPs significantly affected the pharmacokinetics of atorvastatin compared with those of Egyptian volunteers and various ethnic populations.ConclusionsThe CYP3A4*1B and CYP3A5*3 variants were prevalent in the study participants and could impact the effectiveness and safety of atorvastatin therapy. The mutant genotype of the CYP3A4*1B SNP and the CYP3A5*3 SNP led to high atorvastatin levels. Both variants had a notable effect on the pharmacokinetics of atorvastatin among Egyptians compared with healthy Egyptians and volunteers from other ethnic populations. Overall, clinicians can learn more about the impact of both variants in response to atorvastatin.Graphical

The 5-year outcomes of a health-empowerment program on low-income children’s behaviors and quality of life

BackgroundThis study aims to evaluate the 5-year impact of a Health Empowerment Program (HEP) on mitigating problematic conducts and enhancing the health-related quality of life (HRQOL) among children living in poverty.MethodsA prospective cohort study (N = 239, Intervention group: n = 124, Comparison group: n = 115) was established with participants recruited between July 2013 and March 2016 and followed until November 2021. During the 5-year study period, children and their parents from the intervention group were invited to join a multi-dimensional HEP. At baseline and follow-up, both intervention and comparison groups were assessed using the Chinese Strengths and Difficulties Questionnaire (SDQ) and Chinese Child Health Questionnaire Parent Form 28 (CHQ-PF28). Multiple linear regressions were conducted to identify changes in outcome variables as the effect of the HEP.ResultsUpon completion of the 5-year follow-up, children in the intervention group showed a larger decline in conduct problems (B = − 0.66, p <.001), hyperactivity inattention (B = − 0.67, p =.005), and total difficulties score (B = − 1.89, p =.002) of SDQ, a greater increase in prosocial behavior of SDQ (B = 0.53, p =.040), and more substantial enhancement in CHQ-PF28’s psychosocial summary score (B = 2.75, p =.017) compared to the comparison group.ConclusionsHEP is effective in mitigating behavioral problems and improving psychosocial HRQOL of children of low-income families, as evident by this 5-year cohort study.Trial Registration: This study received approval (UW 12–517) from the Institutional Review Board of the University of Hong Kong/Hospital Authority Hong Kong West Cluster.

The Predictive Power of the Mother’s Neck Circumference in the Early Diagnosis of Gestational Diabetes Mellitus

Background: Gestational diabetes mellitus (GDM) is a risk factor for the health of both the mother and fetus, responsible for a significant number of maternal, perinatal, and neonatal complications. Timely diagnosis and effective treatment can reduce the burden of the disease on the health of women and their infants during and after pregnancy. Objectives: The present study aimed to examine the predictive power of the mother’s neck circumference in the early diagnosis of gestational diabetes mellitus. Methods: This prospective cohort study was conducted on 782 pregnant women with a gestational age of 16 weeks who visited health centers in Jiroft between 2020 and 2021. Neck circumference was measured in the 16th week of pregnancy. Gestational diabetes mellitus was diagnosed using an oral glucose tolerance test (OGTT) with 75 grams of glucose at 24-28 weeks of pregnancy. Participants were selected using convenience sampling, and data were collected through interviews with the participants. Results: Among the 782 pregnant women, 179 were diagnosed with GDM, while 603 did not have GDM. The best cut-off point for neck size was determined to be 35.45 cm using the ROC curve. For the neck circumference test, sensitivity was 71.5%, specificity was 60%, positive predictive value was 34.8%, and negative predictive value was 87.7%. Conclusions: The findings indicate that a neck circumference greater than 35.45 cm in early pregnancy (16 weeks) can be considered a new diagnostic test for GDM. Early identification of women at risk should prompt necessary measures to reduce the complications associated with gestational diabetes mellitus.

The Efficacy of Different Tenotomies in the Treatment of Lateral Epicondylitis: A Systematic Review

Background: Lateral epicondylitis impacts 1–3% of the population. It affects nearly half of all tennis players, primarily due to repetitive forearm muscle use leading to pain at the lateral elbow, particularly at the extensor carpi radialis brevis tendon. While conservative treatments resolve most cases, 4–11% of patients with persistent pain require surgery. Tenotomy is the gold standard for repair, but the research comparing the benefits of specific types of tenotomies (open, arthroscopic, percutaneous, ultrasonically assisted, and Tenex forms) is lacking. Methods: PubMed and Embase searches were conducted for articles focused on four tenotomy techniques. The inclusion criteria allowed for the use of randomized controlled trials (RCTs), prospective cohort studies, and comparative observational studies, while the exclusion criteria excluded meta-analyses. Following the PRISMA guidelines, the initial search resulted in 2327 articles. Once the inclusion and exclusion criteria were applied, 1702 articles underwent abstract screening. Finally, 232 articles proceeded to full-text screening, resulting in 37 articles undergoing data extraction. Results: The primary outcomes included functional improvement, pain relief, overall performance, and postoperative disability. The secondary outcomes included patient-reported satisfaction, return-to-work timeframes, and procedural complications. Conclusions: The tenotomy outcomes were similar, regardless of the method, indicating that discussions with patients about their specific outcome preferences may help guide tenotomy method selection.

The minimally clinically important difference in the 2-minute walk test for people in the subacute phase after a stroke

ABSTRACT Background The 2-Minute Walk Test (2MWT) is a simple and reliable test used by clinicians to assess gait function in people with stroke (pwST). No studies established the minimal clinically important difference (MCID) of the 2MWT. Objective To determine the MCID of the 2MWT in subacute pwST using data from a longitudinal cohort study. Methods PwST within 180 days of stroke onset were recruited from the Italian National Health System (NHS) rehabilitation services across the country. Participants underwent physical therapy to improve balance and gait according to their specific needs. The 2MWT was used to assess gait performance at the beginning (T0) and after a minimum of 10 rehabilitation sessions (T1). The Global Perceived Effect (GPE), Activities-specific Balance Confidence Scale (ABC) and the ABC_gait were used to assess balance confidence and the perceived effect of the intervention at T1. Results 51 pwST (69 ± 12 years; 66.7% males) were included in the analysis. Statistically significant improvements were observed in 2MWT, ABC, and ABC_gait scores after rehabilitation using the Wilcoxon signed-rank test. Using an anchor-based approach the receiver operating characteristic (ROC) curves were calculated to establish the MCID. The MCID of the 2MWT was 31 meters with an Area under the curve (AUC) = 0.74 [0.60–0.89], a specificity of 71% and a sensitivity of 63%. Conclusions An improvement of 31 meters on the 2MWT can be considered clinically significant in subacute pwST undergoing rehabilitation. This study provides valuable insights for clinicians to assess walking performance in pwST and determine clinically meaningful changes post-rehabilitation.

Preoperative Predictors of Recurrent Tricuspid Regurgitation After Annuloplasty: Insights into the Role of 3D Echocardiography

Background: While tricuspid annuloplasty (TAP) is an effective treatment option for tricuspid regurgitation (TR), understanding the echocardiographic factors contributing to recurrent TR can help in developing more effective preventive measures to reduce the rate of recurrent TR after TAP. Methods: This study was designed as a prospective observational cohort study to investigate factors contributing to recurrent TR following surgical tricuspid valve (TV) repair in patients with moderate or severe functional TR caused by left heart valvular disease, with severe mitral regurgitation as the dominant pathology. The study included 66 patients who underwent preoperative two-dimensional (2D) and three-dimensional (3D) echocardiographic assessments. Patients were divided into two groups based on TAP outcomes: the effective TAP group and the recurrent TR group. Results: The analysis revealed that 3D-derived both septal–lateral diastolic and systolic tricuspid annulus (TA) diameter (odds ratio (OR) 1.77; 95% confidence interval (CI) 1.17–2.68 and OR 1.62; 95% CI 1.14–2.29, respectively), and major axis diastolic TA diameter (OR 1.59; 95% CI 1.15–2.2) had the highest OR among all echocardiographic parameters. The further univariate analysis of predefined echocardiographic values unveiled that the combined effect of heightened 3D-measured TA major axis diastolic diameter and increased right ventricle (RV) basal diameter exhibited the highest OR at 12.8 (95% CI 2.3–72.8) for a recurrent TR. Using ROC analysis, diastolic major axis (area under the curve (AUC) 0.848; cut-off 48.5 mm), septal-lateral systolic (AUC 0.840; cut-off 43.5 mm) and diastolic (AUC 0.840; cut-off 46.5 mm) TA diameter demonstrated the highest predictive value for recurrent TR from all TV parameters. Conclusions: Recurrent moderate or severe TR after TAP is associated with preoperative TA size, right atrium and RV geometry, but not with changes of RV function. The predictive capacity of 2D-assessed echocardiographic parameters was found to be lower when compared to their corresponding 3D parameters.

Putative risk and resiliency factors after an augmented training program for preventing posttraumatic stress injuries among public safety personnel from diverse sectors

ABSTRACT Mental health disorders are particularly prevalent among public safety personnel (PSP). Emotional Resilience Skills Training (ERST) is a cognitive behavioural training program for PSP based on the Unified Protocol for the Transdiagnostic Treatment of Emotional Disorders (i.e. Unified Protocol). The current study was designed to assess whether ERST is associated with reduced putative risk factors for mental disorders and increased individual resilience. The PSP-PTSI Study used a longitudinal prospective sequential experimental cohort design that engaged each participant for approximately 16 months. PSP from diverse sectors (i.e. firefighters, municipal police, paramedics, public safety communicators) completed self-report measures of several putative risk variables (i.e. anxiety sensitivity, fear of negative evaluation, pain anxiety, illness and injury sensitivity, intolerance of uncertainty, state anger) and resilience at three time points: pre-training (n = 191), post-training (n = 103), and 1-year follow-up (n = 41). Participant scores were statistically compared across time points. Participants reported statistically significantly lower scores on all putative risk variables except pain anxiety, and statistically significantly higher resilience from pre- to post-training. Changes were sustained at 1-year follow-up. The results indicate that ERST is associated with reductions in several putative risk variables and improvement in resilience among PSP.

Health-related quality of life predicts prognosis in individuals with COPD hospitalized with community-acquired pneumonia – a prospective cohort study

Community-acquired pneumonia (CAP) in chronic obstructive pulmonary disease (COPD) often result in sudden and persistent reduction in health-related quality of life (HRQoL), which may be alleviated with palliative care. Among individuals with COPD, we aimed to investigate potential associations between HRQoL at admission with CAP and the risk of re-hospitalization and mortality and potential associations between specific HRQoL domains and CAP treatment outcomes. HRQoL was assessed at admission and the participants were grouped into tertiles based on the HRQoL utility index and specific domains. The results revealed that participants in the middle and highest tertiles of HRQoL had a lower 90-day re-hospitalization risk compared to those in the lowest tertile, whereas no differences in re-hospitalization risk were observed 30 and 180 days after discharge. Almost one in four had severe pain or discomfort at admission and the domain pain or discomfort emerged as a predictor of re-hospitalization. In addition, participants in the middle and highest tertiles had lower risk of 180-day mortality compared to those in the lowest, while no differences were observed in 30-day or 90-day mortality risk. An increased focus on in-hospital palliative care could alleviate the pain and discomfort reported by many participants with potential to reduce re-hospitalization rates.

Leisure-time physical activity, cardiorespiratory fitness, and cognitive decline in middle-aged and older adults - The ELSA-Brasil study

ObjectivesDementia is a fast-growing public health problem. This study examined the association of physical activity and estimated cardiorespiratory fitness (eCRF) with the risk of cognitive impairment. Study designMulticentric, prospective cohort study. MethodsWe analyzed 10,121 participants of the ELSA-Brasil study. We assessed leisure-time physical activity using the long version of the IPAQ questionnaire and defined moderate-to-vigorous physical activity (MVPA) per week. We applied a non-exercise prediction equation to estimate eCRF and classified participants as unfit (lowest tertile) and fit. Leisure-time MVPA and eCRF were measured at baseline and follow-up. Incident cognitive impairment was based on memory, language, and executive function assessed at baseline and follow-up. ResultsDuring a median of 8.1 (7.8–8.5) years of follow-up, we identified 396 (3.9 %) incident cases of cognitive impairment. There was an inverse, non-linear association between the incidence of cognitive impairment and both leisure time MVPA and eCRF. Low eCRF (IRR: 1.29; 95%CI: 1.02, 1.64) and low MVPA (IRR: 1.40; 1.09, 1.82) were independently associated with an increased incidence. Increasing 1 MET in eCRF from baseline to follow-up visit was associated with a lower incidence of cognitive impairment (IRR: 0.80; 95%CI: 0.71, 0.91), while a decrease of 13.7 min per day in leisure time MVPA is associated with an increased incidence (IRR: 1.16; 95%CI: 1.01, 1.33) of cognitive impairment. These associations remained statistically significant in adults under 65 but not in older adults. ConclusionLow eCRF and leisure time MVPA are strong and independent predictors of incident cognitive impairment especially in middle-aged adults.

Where Should We Intervene, 20 Years Later? Case–Control and Prospective Cohort Designs Provide Similar Answers

In 2000, this journal published an influential case–control study identifying dynamic risk factors for sexual recidivism (Hanson &amp; Harris, 2000). In 2017, updated recidivism information for the same sample was obtained with an average follow-up of 20 years. The current study compared the risk factors that differentiated between sexual recidivists and nonrecidivists between the two research designs: original case–control and updated prospective cohort. Of the 82 comparisons, 50 favored the prospective design while 32 favored the case–control; however, most of the differences were small and nonsignificant. Static and dynamic risk factors were approximately equivalent between study designs. Factors identified as sex-specific (e.g., sexual deviancy) were also equivalent between designs while general risk factors (e.g., substance use) were more likely identified in the prospective design. Overall, case–control studies can be used for the identification of risk factors, especially for low base rate behaviors such as sexual recidivism.

Differential target multiplexed spinal cord stimulation in patients with Persistent Spinal Pain Syndrome Type II: a study protocol for a 12-month multicentre cohort study (DETECT)

IntroductionDifferential target multiplexed spinal cord stimulation (DTM SCS) is a new stimulation paradigm for chronic pain management with the aim of modulating glial cells and neurons in order to rebalance...