Age Quartiles Research Articles

Comparing fermented food and vitamin E on exercise-mediated Nrf2/ARE activation in middle-aged/ elderly: A randomized, double-blind clinical study

Objective: This study investigated the effects of fermented papaya preparation (FPP®) and vitamin E on gene expression in middle-aged/elderly individuals, leveraging FPP’s established antioxidant and immune-regulatory benefits. Methods: Graded Exercise Walking Test was administered twice weekly for 6 months. Total Antioxidant capacity (TAC) and gene expression (Nrf2, NQO1, HO-1) in PBMC were measured monthly. Results: Throughout the 6-month study, routine biochemistry and BMI remained stable. Both treatments significantly improved Total Antioxidant Capacity (TAC), Vitamin E exhibiting earlier effects (3 months). Notably, FPP® supplementation led to sustained over-expression of nuclear Nrf2 in all subjects, surpassing Vitamin E’s effects. NQO1 gene expression was rapidly and consistently upregulated in the FPP group, exceeding baseline and Vitamin E levels throughout the study. HO-1 gene expression was upregulated by FPP at 1 month in younger age quartiles (Q1-2) and at 3 and 6 months in all subjects, regardless of age and gender. In contrast Vitamin E did not significantly impact Nrf2, NQO1, or HO-1 gene expression. Conclusion: These findings demonstrate that FPP, unlike Vitamin E, potentiates Nrf2 signaling, triggering a downstream epigenetic cascade. Notably, our clinical data reveal that physical exercise combined with functional food supplementation partially restores impaired Nrf2 signaling in elderly individuals.

Equal performance of the subcutaneous and transvenous implantable cardioverter defibrillator across all age groups in the PRAETORIAN trial

Abstract Introduction The subcutaneous ICD (S-ICD) is developed to overcome lead-related complications and systemic infections, inherent to transvenous ICD (TV-ICD) therapy. In the PRAETORIAN trial the S-ICD proved to be non-inferior to the TV-ICD with regard to inappropriate shocks (IAS) and complications. However, the S-ICD is still mainly the preferred choice in young patients with a long life expectancy and therefore higher risk for lead-related complications. We aimed to evaluate the impact of age on complications and IAS between the S-ICD and TV-ICD. Methods The PRAETORIAN trial is an investigator-initiated, international, multicenter, randomized, two-arm noninferiority trial that was conducted in the United States and Europe. In total 849 patients with a class I or IIa indication for ICD therapy and no pacing indication were randomized to receive an S-ICD (N=426) or TV-ICD (N=423) and followed for a median of 49 months. We compare the occurrence of complications and IAS between increasing quartiles of age. Results Quartile 1 (Q1) consisted of 203 patients aged <55 (109 S-ICD, 94 TV-ICD), Q2 of 199 patients aged 55-62 (100 S-ICD, 99 TV-ICD), Q3 of 232 patients aged 63-69 (111 S-ICD, 121 TV-ICD) and Q4 of 215 patients aged ≥70 (106 S-ICD, 109 TV-ICD). Between the quartiles, there were no significant differences in occurrence of device-related complications (P = 0.32) or IAS (P = 0.66). In Q1, there were 15 (7.4%) complications (5 S-ICD, 10 TV-ICD) and 13 (6.4%) IAS (7 S-ICD, 6 TV-ICD), compared to 20 (10.1%) complications (7 S-ICD, 13 TV-ICD) and 17 (8.5%) IAS (9 S-ICD, 8 TV-ICD) in Q2, 22 (9.5%) complications (12 S-ICD, 10 TV-ICD) and 19 (8.2%) IAS (11 S-ICD, 8 TV-ICD) in Q3 and 18 (8.4%) complications (7 S-ICD, 11 TV-ICD) and 21 (9.8%) IAS (14 S-ICD, 7 TV-ICD) in Q4 (Figure 1.). Figure 2. shows forest plots of the hazard ratios per quartile. Conclusions The S-ICD performed equal to the TV-ICD with regard to IAS and complications between quartiles of age, making the S-ICD a good alternative across all age groups.

High discontinuation rate of statins among PCSK9i users: a nationwide study from 2015-2023

Abstract Background Proprotein convertase subtilisin/kexin type 9 inhibitors (PCSK9i) are recommended as additional lipid-lowering drug treatment for high-risk patients if the low-density lipoprotein cholesterol (LDL-C) targets are not achieved with statins and ezetimibe alone. Nationwide data from clinical practice on the use of PCSK9i are lacking. In 2015, PCSK9i became available in Norway with reimbursement restricted to patients with familial hypercholesterolemia (FH) and/or atherosclerotic cardiovascular disease (ASCVD) with LDL-C above certain levels. Purpose To investigate the use and adherence of lipid lowering drugs among a nationwide cohort of PCSK9i users, utlizing complete pharmacy dispensation data. Methods Information on all PCSK9i users ≤80 years with at least one year of follow-up after the first dispensation were extracted from the Norwegian Prescribed Drug Registry. We evaluated adherence to PCSK9i by calculating the proportion of days covered (PDC) during the initial year of PCSK9i therapy. Poor adherence was defined as PDC <80%, and discontinuation was defined as a gap in treatment ≥180 days during the follow-up period. We analyzed treatment patterns of statins and ezetimibe during the 1-year period before and after PCSK9i initiation by determining the proportion of patients with at least one dispensation of statin and/or ezetimibe treatment. Results A total of 2,997 PCSK9i users were identified. Median age at treatment initiation was 62 (IQR: 13) years and 43% were female. Non-adherence to PCSK9i was observed in 16% of the patients, and 18% discontinued treatment (Table). Non-adherence to PCSK9i was more prevalent in females, and in the lowest and highest age quartiles. No significant difference in non-adherence was found among patients with ASCVD compared to patients with FH. In the year preceding PCSK9i initiation, 74% of patients used statins (including combinations with ezetimibe), 11% used ezetimibe monotherapy, and 15% did not use any statin or ezetimibe treatment (Figure). During the year following PCSK9i initiation, 35% used statins (including combinations), 17% used ezetimibe monotherapy, and 48% did not use any statin or ezetimibe treatment. Among patients with ASCVD, 72% used statins prior to PCSK9i initiation, and 22% used statins after. Among patients with FH, 77% used statins prior to PCSK9i initiation, while 51% used statins after. Conclusion In this nationwide study of incident PCSK9i users, we observed a substantial decrease in usage of statins and ezetimibe following PCSK9i initiation. Further, almost 1 in 5 patients discontinued treatment with PCSK9i. There is a large potential for optimizing treatment and adherence to PCSK9i and conventional lipid-lowering drugs among Norwegian patients with ASCVD and familial hypercholesterolemia.Adherence and discontinuation to PCSK9iUse of statin and ezetimibe

A Demographic Description of Children and Adolescents With Concomitant Autism and Anxiety Along With a Comparison of Receipt of Psychological Services

Objective: (1) Evaluate differences in demographic distributions between those with autism alone and those with autism concomitant with anxiety and (2) assess demographic factors associated with receipt of psychological therapy in patients with autism. Methods: Using deidentified health care claims data, we extracted all encounters among children with the International Classification of Diseases-10-CM for Autism Spectrum Disorder (F84) and flagged those with concomitant anxiety (F41.9). Extracted data included age, sex, race, ethnicity, insurance status, and Rural-Urban Continuum Codes. Current procedural terminology codes for psychological services were extracted. Data were analyzed using Mann–Whitney U tests, χ2 tests of association, and logistic regression. Results: Demographic differences between children/adolescents with autism alone versus autism concomitant with anxiety were noted for age, sex, and race/ethnicity, with a greater prevalence of autism/anxiety identified in older-aged children and children identifying as female and non-Hispanic White residing in an urban area. While 21% of those included in this study had received psychotherapy, the percentages within the autism only and autism/anxiety groups were 12% and 50%, respectively (p < 0.001). Children/adolescents who were older age quartile, resided in an urban residence, and with a concomitant diagnosis of anxiety were more likely to receive psychological services, while non-Hispanic Other were less likely to, compared with the reference of non-Hispanic White. Conclusion: We identified demographic disparities in the diagnosis of autism versus autism with concomitant anxiety, including age, sex, race/ethnicity, and residence location. Age quartile, urban location, and concomitant anxiety were associated with increased likelihood of receipt of psychological services.

Exploring relationships between smoke exposure, housing characteristics, and preterm birth in California

Pregnant people are vulnerable to air pollution exposure, including risk of preterm birth, low birth weight, and stillbirth. Understanding the infiltration of outdoor wildfire smoke into a residential space is critical for the accurate assessment of wildfire smoke exposure and associated health effects in pregnant people. Relying on ambient measurements of wildfire smoke alone can result in exposure misclassification. In this study, we examine the role of physical housing characteristics in the relationship between smoke exposure and preterm birth. In particular, we examine the effect of home size, year of construction, cooling type, and renovation status, as effect modifiers in the relationship between smoke exposure during pregnancy and preterm birth from 2007 to 2015 in California. To do this, we combined data on home characteristics from the California Tax Assessor, birth outcomes from the California birth records database, and the number of smoke days for each pregnancy from the NOAA (National Oceanic and Atmospheric Administration) Hazard Mapping System (HMS). We estimated the association between smoke day exposures and odds of preterm birth using logistic regression models and stratified by air basin and housing characteristics. Our findings reveal that cooling type and renovation status are key factors modifying the smoke exposure-preterm birth relationship. Notably, we found elevated associations for people living in unrenovated homes, those using evaporative cooling systems, and those using central air conditioning units. While we observed elevated odds of preterm birth associated with increasing smoke day exposure for residents of large and new homes, this effect does not significantly differ across home size and age quartiles. This study highlights the need to further examine the relative roles of housing characteristics as well as factors not measured here including behavioral factors, time spent outdoors, window use, and occupational exposures in driving adverse birth outcomes related to wildfire smoke exposure.

The predictive capability of several anthropometric indices for identifying the risk of metabolic syndrome and its components among industrial workers

Metabolic syndrome (MetS) is closely associated with adverse cardiometabolic outcomes. The objective of this study was to identify practical methods that could enable the effective identification of MetS based on anthropometric indices. The basis of our study involved retrospective database obtained from routine medical prophylactic examinations. This was a cross-sectional study on the health status of male workers employed in hazardous working conditions at industrial enterprises in the Ural region conducted in 2019. A total of 347 male workers employed under hazardous working conditions were investigated. The presence of MetS was established by a healthcare professional in accordance with the guidelines of the International Diabetes Federation (IDF). Simple linear regression was used to evaluate the associations between anthropometric indices and MetS incidence. Logistic regression was used to determine the odds ratios of MetS in relation to increases in anthropometric indices. ROC curves were calculated to compare the ability of each anthropometric index to predict MetS and to determine the diagnostic thresholds of the indicators considered. According to the IDF criteria, 36.3% of the workers had MetS. A direct relationship was found between the individual components of MetS and the anthropometric indices studied. The highest OR was shown by the Body Roundness Index (BRI) of 2.235 (95% CI 1.796–2.781). For different age quartiles, the optimal cut-off values for predicting MetS were as follows: BRI, 4.1–4.4 r.u.; body shape index (ABSI), 0.080–0.083 m11/6 kg−2/3; and lipid accumulation product (LAP), 49.7–70.5 cm mmol/l. The most significant associations with MetS were observed where the values were greater than these cut-off points (Se = 97.4%). The results of this study demonstrated the rapid use of new anthropometric indicators, which have shown good predictive ability and are quite easy to use.

Effects of age on microvascular function in patients with normal coronary arteries.

It has been suggested that coronary microvascular function decreases with age, irrespective of the presence of epicardial atherosclerosis. Our aim is to quantitatively investigate the effects of age on microvascular function in patients with normal coronary arteries. In 314 patients with angina with no obstructive coronary artery disease (ANOCA), microcirculatory function was tested using the continuous thermodilution method. In 305 patients, the association between age and both resting and hyperaemic myocardial blood flow (Q), microvascular resistance (Rμ), absolute coronary flow reserve (CFR) and microvascular resistance reserve (MRR) was assessed. In addition, patients were divided into 3 groups to test for differences based on age quartiles (≤52 years [24.9%], 53-64 years [49.2%], ≥65 years [25.9%]). The mean age was 59±9 years with a range from 22 to 79 years. The mean resting Q (Qrest) was not different in the 3 age groups (88±34 mL/min, 82±29 mL/min, and 86±38 mL/min, R2=0.001; p=0.62). A trend towards a decreasing mean hyperaemic Q (Qmax) was observed with increasing age (223±79 mL/min, 209±84 mL/min, 200±80 mL/min, R2=0.010; p=0.083). The mean resting Rμ (Rμ,rest) were 1,204±460 Wood units (WU), 1,260±411 WU, and 1,289±455 WU (p=0.23). The mean hyperaemic Rμ (Rμ,hyp) increased significantly with advancing age (429±149 WU, 464±164 WU, 503±162 WU, R2=0.026; p=0.005). Consequently, MRR decreased with age (3.2±1.2, 3.1±1.0, 2.9±0.9; p=0.038). This trend was present in both the patients with (n=121) and without (n=184) coronary microvascular dysfunction (CMD). There is an age-dependent physiological increase in minimal microvascular resistance and decrease in microvascular function, which is represented by a decreased MRR and is independent of atherosclerosis. The age-dependent decrease in MRR was present in both patients with and without CMD and was most evident in patients with smooth coronary arteries.

#2146 Gender difference in hospital-acute kidney injury epidemiology and outcome: not just a matter of sex

Abstract Background and Aims Hospital Acute kidney injury (H-AKI) is a complex entity associated with an increased risk of complications and mortality. Its occurrence and outcome are influenced by several patient and organizational-related factors. Due to the biological and genetic differences, sex may greatly influence the kidney function. However, the impact of sex on H-AKI risk and related consequences is still unclear. This retrospective study aimed to assess H-AKI epidemiology and outcomes in a large cohort of hospitalized patients, with a focus on the association with patients' sex. Method From adult patients admitted to two large University Hospitals in Italy between 2016 and 2019, we collected clinical data, serum creatinine (sCr), comorbidities and primary diagnoses as codified in the hospital discharge form (HDF), and data on discharge, length of hospital stay (LOS), and death. Patients with Chronic kidney disease (CKD) stage 5 reported on HDF were excluded. We defined and graded AKI according to the KDIGO criteria, by comparing the peak sCr to the lowest sCr during hospitalization under the assumption that the lowest sCr would represent baseline kidney function. The estimated glomerular filtration rate (eGFR) was calculated using the Chronic Kidney Disease Epidemiology Collaboration creatinine-based equation. Results We analyzed 87,087 patients, with an average age of 69.2 ± 17.7 years of whom 43467 (49.9%) were males and 43620 females (50.1%). Female patients were older than males (69.9 ± 16.5 vs 68.5 ± 18.9 years, p < 0.001), had less prevalence of diabetes mellitus (DM) [3797 (8.7%) vs 4695 (11.8%), p < 0.001] and CKD [2609 (6%) vs 3340 (7.7%), p = 0.001] and higher prevalence of heart failure (HF) [4083 (9.3%) vs 3729 (8.6%), p < 0.001]. Admission eGFR was lower in females than males [82.6 (54.5-99.1) vs 84.2 (57.8-99.0) ml/min, p < 0.001] (see Fig. 1). Overall, 17946 patients (20.6%) developed H-AKI, with a higher incidence in females (21.4% vs. 19.8%, p = 0.000). Females with H-AKI were older and exhibited more heart failure, while males presented more acute myocardial ischemia and sepsis. The male/female ratio varied across AKI severity, with stage 3 AKI more frequent in males. AKI awareness, as evaluated by comparing the incidence of AKI diagnosed according to the sCr changes with AKI diagnoses codified on HDF, showed a higher rate of undetection in females. Moreover, when we stratified our cohort according to the age quartiles, we observed that for each AKI stage in the 1st age quartile H-AKI incidence was higher in males, in the second quartile there was no difference between male and female patients, while in the last quartiles, AKI incidence was higher in females (Fig. 2). This tendency was also confirmed by Kaplan-Meier analysis. However, when we separately analyzed the risk of developing AKI in the different quartiles with multivariate logistic regression analysis we found that while in the youngest quartiles the risk of developing AKI was not correlated with sex, in the elderly, female sex was an independent risk factor for developing AKI (3rd quartile OR 1.30, IC 1.21-1.39; 4th quartile OR 1.46 IC 1.38-1.59, adjusted for age, DM, HF, CKD, admission to ICU, sCr, LOS). The analysis of outcomes among AKI patients (Fig. 3) showed that mortality was the same for the youngest patients, while it was higher in male patients for the 3rd and 4th age quartile. A similar trend was found for ICU admission and LOS. Conclusion Sex emerges as a significant determinant of H-AKI development. However, the relationship between sex and H-AKI is not linear. Indeed, AKI incidence, severity, and outcomes vary between males and females across different age groups, probably reflecting the modifications of health status occurring during a lifetime. Consideration of gender differences is crucial in studying AKI to ensure accurate and equitable diagnosis and management.

Clinical trial on nurse training through virtual reality simulation of an operating room: assessing satisfaction and outcomes

IntroductionVirtual reality (VR) provides a firsthand active learning experience through varying degrees of immersion. The aim of this study is to evaluate the use of VR as a potential tool for training operating room nurses to perform thoracic surgery procedures. MethodsThis is an open parallel-group randomized clinical trial. One group received basic formation followed by an assessment module. The experimental group received the same basic formation, followed by thoracic surgery training and an assessment module. ResultsFifty-six nurses participated in the study (51 females), with a mean age of 41.6 years. Participants achieved a median evaluation mode score of 480 points (IQR = 32 points). The experimental group (520 points) achieved an overall higher score than the control group (440 points; P = .04). Regarding age, women in the second quartile of age among the participants (35–41 years) achieved significantly better results than the rest (P = .04). When we evaluated the results based on the moment of practice, exercises performed in the last 10 min obtained better results than those performed in the first 10 min (1064 points versus 554 points; P < .001). Regarding adverse effects blurred vision was the most frequent. The overall satisfaction rating with the experience was 8.5 out of 10. ConclusionVirtual reality is a useful tool for training operating room nurses. Clinical trial with ISRCTN16864726 registered number.

Global scholarly output on orthodontic temporary anchorage devices (TADs): A silver jublee scientometric analysis.

This study aimed to analyze the global scholarly production of articles related to temporary anchorage devices (TADs) from 1998-2023 in peer-reviewed dental journals indexed in the Web of Science. Adatabase of TADs-related articles was created via aWeb of Sciences structured search. The bibliometric characteristics of the studies, including the number of citations, publication year, journal title, journal impact factor (IF), authorship, contributing institutions and countries, thematic field, and study design, were extracted. Keyword co-occurrence network analyses and the correlation between the number of citations and the article age, journal IF, and journal quartile of each article were performed. The top50 cited articles were published from 1999-2016, and the total number of citations ranged from 82-602, with 160.36 citations/paper on average. Most of the articles originated from Japan (n = 12), with the most remarkable contributions from Nihon and Okayama Universities, Japan (n = 5, each). The American Journal of Orthodontics and Dentofacial Orthopedics had the most cited articles, with 196.57 citations/paper on average. Asignificant positive correlation occurred between the number of citations and publication age (rho = 0.392, P = 0.005). Our scientometric analysis reported the characteristics of TADs-related articles published over 25years. Most highly-cited articles were published between 2005 and 2008. The positive correlation between articles' publication date and the number of citations might impact the top50 within the next 5-10years.

Association between age at diagnosis and all-cause mortality in type 2 diabetes: the Renal Insufficiency and Cardiovascular Events (RIACE) Italian Multicenter Study

AimsIt is unclear whether type 2 diabetes diagnosed in young adulthood is associated with increased severity than that occurring later in life beyond longer lifetime exposure to hyperglycemia. This study aimed at assessing the independent association of age at type 2 diabetes diagnosis with all-cause mortality.MethodsThis prospective cohort study enrolled 15,773 Caucasian patients with type 2 diabetes in 19 Italian centers in 2006–2008. Cardiometabolic risk profile and presence of complications and comorbidities were assessed at baseline and participants were stratified by quartiles of age at diabetes diagnosis. All-cause mortality was verified on 31 October 2015.ResultsValid information on vital status was retrieved for 15,656 participants (99.3%). Patients in the lowest quartile had the longest diabetes duration, the worst glycemic control and the highest prevalence of insulin treatment, obesity, atherogenic dyslipidemia, and smoking habits. All complications were inversely associated with age at diabetes diagnosis after adjustment for age and sex, but not after further adjustment for diabetes duration. Percentages of death, Kaplan–Meier estimates, and unadjusted hazard ratios and mortality rates increased from the lowest to the highest quartile. In contrast, when adjusting for age and sex, participants falling in the lowest quartile, showed the highest mortality risk [hazard ratio 1.321 (95% confidence interval 1.196–1.460), P < 0.0001]. However, differences among quartiles disappeared after adjustment for diabetes duration, complications/comorbidities, or other cardiovascular risk factors.ConclusionsType 2 diabetes onset in young adulthood is associated with increased mortality that is mainly driven by longer diabetes duration favoring the development of complications.Trial registration: ClinicalTrials.gov, NCT00715481, retrospectively registered 15 July, 2008.

Early life cow level risk factors for sole ulcers in primiparous dairy cows

Sole ulcers negatively affect cow welfare and production economy. Previous cases of sole ulcers increase the risk of new or recurrent cases, and prevention of sole ulcers during the first lactation may therefore have a long-term effect, also in later lactations. Until now, risk factors for sole ulcers in the first lactation, associated with the period before heifers calve for the first time, have not been investigated. This study evaluated ‘early life’ cow level risk factors for sole ulcers at the first hoof trimming in the first lactation. ‘Early life’ risk factors were defined as risk factors associated with the period before a cow calves for the first time. A data set including information about all hoof trimming recordings during the years 2020 to 2022, and information about individual cows, was retrieved from the Danish Cattle Database. The data set included only primiparous cows, and only cows that were hoof trimmed at least once during the first lactation. Overall, 1.95% of 466,113 cows included in the study had sole ulcers at the first hoof trimming in the first lactation. Results from a logistic regression model demonstrated a statistically significant interaction between breed and age at first calving (grouped based on quartiles within breed). Overall, across breeds, odds ratios of sole ulcers at the first hoof trimming in the first lactation were generally approximately 0.5 in the 1st quartile of age at first calving, approximately 0.6 in the 2nd quartile, and approximately 0.75 in the 3rd quartile, compared with the 4th quartile within the same breed. Odds of sole ulcers were generally higher in Jersey and Danish Red Dairy cows, compared with Holstein. In conclusion, the odds of sole ulcers in the first lactation increased with increasing age at first calving, and was approximately twice as high in cows calving among the oldest 25% within a breed, compared with cows calving among the youngest 25%. Focus on early life risk factors for sole ulcers may have a major influence on the occurrence of sole ulcers throughout the life of cows.

Association Between Defibrillation Using LIFEPAK 15 or ZOLL X Series and Survival Outcomes in Out-of-Hospital Cardiac Arrest: A Nationwide Cohort Study.

Defibrillation is essential for achieving return of spontaneous circulation (ROSC) following out-of-hospital cardiac arrest (OHCA) with shockable rhythms. This study aimed to investigate if the type of defibrillator used was associated with ROSC in OHCA. This study included adult patients with OHCA from the Danish Cardiac Arrest Registry from 2016 to 2021 with at least 1 defibrillation by the emergency medical services. We used multivariable logistic regression and a difference-in-difference analysis, including all patients with or without emergency medical services shock to assess the causal inference of using the different defibrillator models (LIFEPAK or ZOLL) for OHCA defibrillation. Among 6516 patients, 77% were male, the median age (quartile 1; quartile 3) was 70 (59; 79), and 57% achieved ROSC. In total, 5514 patients (85%) were defibrillated using LIFEPAK (ROSC: 56%) and 1002 patients (15%) were defibrillated using ZOLL (ROSC: 63%). Patients defibrillated using ZOLL had an increased adjusted odds ratio (aOR) for ROSC compared with LIFEPAK (aOR, 1.22 [95% CI, 1.04-1.43]). There was no significant difference in 30-day mortality (aOR, 1.11 [95% CI, 0.95-1.30]). Patients without emergency medical services defibrillation, but treated by ZOLL-equipped emergency medical services, had a nonsignificant aOR for ROSC compared with LIFEPAK (aOR, 1.10 [95% CI, 0.99-1.23]) and the difference-in-difference analysis was not statistically significant (OR, 1.10 [95% CI, 0.91-1.34]). Defibrillation using ZOLL X Series was associated with increased odds for ROSC compared with defibrillation using LIFEPAK 15 for patients with OHCA. However, a difference-in-difference analysis suggested that other factors may be responsible for the observed association.

Idiopathic intracranial hypertension and obstetric and neonatal outcomes: A 1:20 matched study from a population database.

Idiopathic intracranial hypertension (IIH), also known as pseudotumor cerebri, is a common pathology in reproductive-aged women, although data regarding pregnancy outcomes are scarce. In the present study, we aimed to compare pregnancy and perinatal outcomes between women who suffered from IIH to those who did not. A retrospective cohort study using the Healthcare Cost and Utilization Project, Nationwide Inpatient Sample. All pregnant women who delivered or had a maternal death in the US (2004-2014) were included. Women with an ICD-9 diagnosis of IIH before or during pregnancy were matched to controls without IIH according to age, race, insurance type, and income quartile, in a 1:20 ratio. Pregnancy, delivery, and neonatal outcomes were compared between the two groups. Overall, 9 096 788 deliveries were identified. Of these, 1454 women (0.016%) had a diagnosis of IIH (study group) and were compared to 29 080 women without IIH (control group). Women with IIH, compared to those without, were more likely to be obese (body mass index >30 kg/m2) and suffer from pregestational diabetes mellitus and chronic hypertension (P < 0.001, all). After adjusting for confounders, patients in the IIH group, compared to those without, had a higher rate of pregnancy-induced hypertension (aOR 1.82, 95% CI: 1.57-2.1, P < 0.001), pre-eclampsia (aOR 1.98, 95% CI: 1.61-2.45, P < 0.001), preterm delivery (aOR 1.88, 95% CI: 1.59-2.23, P < 0.001), CD (aOR 2.41, 95% CI: 2.12-2.73, P < 0.001), wound complications (aOR 3.2, 95% CI: 1.89-5.42, P < 0.001), and congenital anomalies (aOR 2.18, 95% CI: 1.4-3.4, P < 0.001). Women with IIH had a higher incidence of obstetrical complications, including preterm deliveries, hypertensive disorders of pregnancy, and congenital anomalies.

Application of restorative neurostimulation for chronic mechanical low back pain in an older population with 2-year follow up

IntroductionData on the Medicare-aged population show that older patients are major consumers of low back pain (LBP) interventions. An effective approach for patients with mechanical LBP that has been refractory...

(123) Postoperative Changes of Serum Total Testosterone Levels in Patients with Prostate Cancer After Robot-Assisted Radical Prostatectomy

Abstract Introduction Although a relationship between prostate cancer and serum total testosterone (TT) has been studied, previous evidences were contradictory. Although a relationship between prostate cancer and serum total testosterone (TT) in terms of cancer biology as well as sexual function has been studied, previous evidences were contradictory and not organized very well. Objective We investigated the changes in TT levels after robot-assisted radical prostatectomy (RARP) for prostate cancer as a prospective surveillance. Methods From July 2015 to January 2022, 290 patients out of 1,343 prostate biopsies performed in our hospital underwent RARP with a diagnosis of localized prostate cancer. TT measurements were performed at 6:00 early morning on admission to all patients for biopsy. Of these, we studied 76 patients whose TT values have been measured during postoperative follow-up. TT values were measured 1 month after RARP, every 3 months until 36 months thereafter, and every 6 to 12 months thereafter for up to 72 months postoperatively. Results The median and quartile of age, serum PSA and TT (pre-TT) values at biopsy of the 76 patients were 69 years (64–72 years), 7.47 ng/mL (5.65–12.74 ng/mL) and 4.03 ng/mL (2.96–4.83 ng/mL), respectively. There was no significant correlation between age and pre-TT values (p = 0.21). RARP was performed an average of 2.9 months after biopsy. The median follow-up period was 43 months (31–60 months). PSA recurrence was observed in 18 patients (23.7%), with 3- and 5-year PSA non-recurrence rates of 77.4% and 74.9%, respectively. There was no significant difference in pre-TT values between patients with or without PSA recurrence (p = 0.107). Analysis of TT values at each observation period after RARP showed relative increase by an average of 23.4% (after 1 month) to 41.6% (after 36 months) when compared with pre-TT values. Further analysis of dividing 76 patients into 2 groups by a pre-TT value of 3.00 ng/mL showed that only in the low pre-TT group (pre-TT &amp;lt; 3.00 ng/mL: 21 cases, 27.6%), the rate of increase in TT values over pre-TT was significantly higher than that in the normal pre-TT group (pre-TT ≥ 3.00 ng/mL: 55 cases, 72.4%) at each observation period up to 72 months after RARP except 33 and 54 months Conclusions The transition of postoperative TT values in the patients who underwent RARP continued to show a significant increase at each observation period only in the group with low TT values preoperatively, suggesting that biochemical hypogonadism may have been presumably caused by prostate cancer-bearing conditions preoperatively in these patients with low TT values. Disclosure No.

Incidence and Prediction of Unrelated Mortality After Successful Endoscopic Eradication Therapy for Barrett’s Neoplasia

Background & AimsFollow-up (FU) strategies after endoscopic eradication therapy (EET) for Barrett’s neoplasia do not consider the risk of mortality from causes other than esophageal adenocarcinoma (EAC). We aimed to evaluate this risk during long-term FU, and to assess whether the Charlson Comorbidity Index (CCI) can predict mortality. MethodsWe included all patients with successful EET from the nationwide Barrett registry in the Netherlands. Data were merged with National Statistics for accurate mortality data. We evaluated annual mortality rates (AMRs, per 1000 person-years) and standardized mortality ratio for other-cause mortality. Performance of the CCI was evaluated by discrimination and calibration. ResultsWe included 1154 patients with a mean age of 64 years (±9). During median 59 months (p25–p75 37–91; total 6375 person-years), 154 patients (13%) died from other causes than EAC (AMR, 24.1; 95% CI, 20.5–28.2), most commonly non-EAC cancers (n = 58), cardiovascular (n = 31), or pulmonary diseases (n = 26). Four patients died from recurrent EAC (AMR, 0.5; 95% CI, 0.1–1.4). Compared with the general Dutch population, mortality was significantly increased for patients in the lowest 3 age quartiles (ie, age <71 years). Validation of CCI in our population showed good discrimination (Concordance statistic, 0.78; 95% CI, 0.72–0.84) and fair calibration. ConclusionThe other-cause mortality risk after successful EET was more than 40 times higher (48; 95% CI, 15–99) than the risk of EAC-related mortality. Our findings reveal that younger post-EET patients exhibit a significantly reduced life expectancy when compared with the general population. Furthermore, they emphasize the strong predictive ability of CCI for long-term mortality after EET. This straightforward scoring system can inform decisions regarding personalized FU, including appropriate cessation timing. (NL7039)

6. USING VIRTUAL REALITY TO SIMULATE AN OPERATING ROOM: SATISFACTION AND RESULTS FROM THE FIRST PILOT STUDY FOR NURSES

Abstract Introduction Virtual reality (VR) provides a firsthand active learning experience through varying degrees of immersion. The aim of this pilot study is to evaluate the use of VR as a potential tool for training operating room nurses to perform thoracic surgery procedures. Methods This is an open parallel-group randomized clinical trial. One group will receive basic training followed by an assessment module. The experimental group will receive the same basic training, followed by thoracic surgery training, and then an assessment module. Results Fifty-five nurses participated in the study (50 females), with a mean age of 41.6 years. The average score obtained by each participant in the evaluation mode was 477 points. The experimental group (513 points) achieved an overall higher score than the control group (445 points; p=0.04). Regarding age, women in the second quartile of age among the participants (35-41 years) achieved significantly better results than the rest (p=0.04). When evaluating results based on the practice moment, exercises performed in the last 10 minutes yielded better results than those performed in the first 10 minutes (1064 points versus 554 points; p &amp;lt;0.001). The most frequent adverse effect reported was blurred vision. The overall satisfaction rating with the experience was 8.5 out of 10. Conclusion Virtual reality is a useful tool for training operating room nurses.

(359) Vasectomy Trends in Western NY Following Dobbs v. Jackson Women’s Health Organization

Abstract Introduction On June 24, 2022, the United States Supreme Court ruled on Dobbs v. Jackson Women’s Health Organization (Dobbs) that the Constitution of the United States does not confer a right to abortion. The court’s decision overruled both Roe v. Wade (1973) and Planned Parenthood v. Casey (1992), giving individual states the full power to regulate any aspect of abortion not protected by federal law. Objective Our study aims to identify the difference, if any, in the number of vasectomies performed in Western NY before and after the ruling on Dobbs v. Jackson Women’s Health Organization. Methods We performed a retrospective chart review of 2428 patients who had vasectomies in Western New York from August 2021 – March 2023. Leveraging a dataset containing de-identified patient information, we compared the rates of all men undergoing vasectomies in the six-month period before and after the ruling. Vasectomy case information collected by urologists in Buffalo dating back to 1996 was collected and tabulated using Excel. Statistical analyses were performed to compare differences in both the overall change in frequency of vasectomies among all men in the six-month period before and after the court decision, as well as by specific demographic groups. Statistical analyses were performed in R and SAS. Results Men with no children had a statistically significant increase (p=0.009) in the number of vasectomies in the six-month period after the Dobbs decision (n=138) compared to before (n=98). Rates of vasectomies pre- and post- Dobbs were organized by age quartiles (&amp;lt;33.20, 33.20-36.65, 36.66-40.59, ≥40.60). In the “No Child” group, men with ages &amp;lt;33.2 (p=0.0137) and ages 33.2-36.65 (p=0.0394) had significant increases in frequency of vasectomy after the court decision. Conclusions Our data demonstrates that in the wake of Dobbs v. Jackson Women’s Health Organization (2022), the number of vasectomies among men with no children significantly increased after the court decision. There were significant increases in the number of vasectomies within different age groups of men without children following the decision. Future aims of this study will seek to create statistical models to determine the underlying reasons that influenced the observed change in frequency of vasectomies following the court decision in men without children. Disclosure No.

Um estudo observacional piloto para identificar valores de referência para o teste de caminhada de 6 minutos em hipertensos brasileiros

Abstract Introduction Systemic arterial hypertension (SAH) is responsible for 9.5 million deaths in the global popu-lation. Lifestyle factors, including physical inactivity, are important modifiable risk factors in the development of SAH. Thus, physical exercise has been shown to be effective to control SAH and before the prescription, the six-minute walk test (6-MWT) has been commonly used to assess the physical capacity. Objective To propose reference values for the 6-MWT test in Brazilian people with SAH. Methods A cross-sectional observational study was conducted with 302 hypertensive subjects (62.61 + 10.93 years) admitted to a cardiac rehabilitation program. Participants were divided into different age quartiles and submitted to 6-MWT. The walking distance data was compared between the quartiles and adjusted by mul-tiple linear regression analysis. Results The hypertensive subjects walked 388.07 + 115.03 m during the 6-MWT. No significant difference between the genders was found. However, when the age quartiles were compared, for the 46–59 age group, the women walked less than the men. Intra-group comparisons showed that the distance walked in the 6-MWT decreased with the increase in age, in both men and women. Conclusion The present study provides reference values for the 6-MWT, both for Brazilian men and women of different age groups. This data may be an important parameter for future clinical studies, prevention strategies, and clinical intervention.